Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC008896 | PA |
NPI | 1063549756 |
---|---|
Provider Name | Dr. Jason Weigner |
First Address | Brookhaven, PA 19015-3104 |
Second Address | Brookhaven, PA 19015-3104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1419443 | HIGHMARK BS OF PA PIN (01) | PA |
2105742000 | INDEPENDENCE BC OF PA PIN (01) | PA |
U96171 | (02) | PA |