Provider Demographics
NPI:1881872943
Name:WELDON, BARBARA JEANNE (DC)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:JEANNE
Last Name:WELDON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:WELDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC CHIROPRACTOR
Mailing Address - Street 1:1704 FIFTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1811
Mailing Address - Country:US
Mailing Address - Phone:415-350-1054
Mailing Address - Fax:415-258-8289
Practice Address - Street 1:700 E STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-350-1054
Practice Address - Fax:415-258-8289
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0246630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU65151Medicare UPIN