Provider Demographics
NPI:1780803304
Name:WEISS, DON M (DC)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:M
Last Name:WEISS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 JOHNSON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2732
Mailing Address - Country:US
Mailing Address - Phone:215-887-7100
Mailing Address - Fax:
Practice Address - Street 1:453 JOHNSON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2732
Practice Address - Country:US
Practice Address - Phone:215-887-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC2685L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA69982Medicare UPIN
PA69982Medicare ID - Type Unspecified