Provider Demographics
NPI:1801845557
Name:WEISE, JOHN PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:WEISE
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 1:27430 FORD RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2919
Mailing Address - Country:US
Mailing Address - Phone:734-421-4040
Mailing Address - Fax:734-421-4040
Practice Address - Street 1:27430 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2919
Practice Address - Country:US
Practice Address - Phone:734-421-4040
Practice Address - Fax:734-421-4040
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H25000OtherBCBSM
MI11291808OtherCAQH
MI11291808OtherCAQH