Provider Demographics
NPI:1801944285
Name:WEISS, MARK STEVEN (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
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 1:1343 VINA DEL MAR CIR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870
Mailing Address - Country:US
Mailing Address - Phone:714-809-2408
Mailing Address - Fax:
Practice Address - Street 1:1001 E IMPERIAL HWY
Practice Address - Street 2:A-1
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5619
Practice Address - Country:US
Practice Address - Phone:714-256-0411
Practice Address - Fax:714-256-0511
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV11829Medicare UPIN
CAWDC23403AMedicare PIN