Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC002454-L | PA |
NPI | 1306972237 |
---|---|
Provider Name | Dr. Kirk Weldon Weber |
First Address | Fenelton, PA 16034 |
Second Address | Fenelton, PA 16034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25-1780930 | (02) | PA |