Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 416 | ND |
NPI | 1174524318 |
---|---|
Provider Name | Dr. Joel Charles Weiss |
First Address | Fargo, ND 58102-2502 |
Second Address | Fargo, ND 58102-2502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14045 | (05) | ND |
4308 | ND BLUE CROSS/BLUE SHIELD (01) | ND |
8Z158WE | MN BLUE CROSS/BLUE SHIELD (01) | MN |
T66834 | (02) |