Provider Demographics
NPI:1912119173
Name:WEBER CHIROPRACTIC CLINIC SC
Entity Type:Organization
Organization Name:WEBER CHIROPRACTIC CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-326-2511
Mailing Address - Street 1:62800 COLLINS LN
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821
Mailing Address - Country:US
Mailing Address - Phone:608-326-8792
Mailing Address - Fax:
Practice Address - Street 1:601 E BLACKHAWK AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821
Practice Address - Country:US
Practice Address - Phone:608-326-2511
Practice Address - Fax:608-326-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3386-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI350038301OtherRAILROAD MEDICARE
WI38896800Medicaid
WI=========012OtherBLUE CROSS BLUE SHIELD
WI=========012OtherBLUE CROSS BLUE SHIELD
WI350038301OtherRAILROAD MEDICARE