Provider Demographics
NPI:1912953282
Name:WEBER, MICHAEL D (DC, ART)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:WEBER
Suffix:
Gender:M
Credentials:DC, ART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 NORTH AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1572
Mailing Address - Country:US
Mailing Address - Phone:605-642-1000
Mailing Address - Fax:605-642-1100
Practice Address - Street 1:1230 NORTH AVE STE 7
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1572
Practice Address - Country:US
Practice Address - Phone:605-642-1000
Practice Address - Fax:605-642-1100
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0080142OtherBLUE CROSS BS / WELLMARK
SD7603332Medicaid
SD0080142OtherBLUE CROSS BS / WELLMARK
SD7603332Medicaid