Provider Demographics
NPI:1063549756
Name:WEIGNER, JASON (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:WEIGNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-3104
Mailing Address - Country:US
Mailing Address - Phone:610-876-6180
Mailing Address - Fax:610-876-6130
Practice Address - Street 1:3215 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-3104
Practice Address - Country:US
Practice Address - Phone:610-876-6180
Practice Address - Fax:610-876-6130
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008896111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1419443OtherHIGHMARK BS OF PA PIN
PA2105742000OtherINDEPENDENCE BC OF PA PIN
PA2105742000OtherINDEPENDENCE BC OF PA PIN
PAU96171Medicare UPIN