Provider Demographics
NPI:1124504840
Name:WEISS, MICHAEL JACOB (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JACOB
Last Name:WEISS
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 1:12087 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-8758
Mailing Address - Country:US
Mailing Address - Phone:989-860-8972
Mailing Address - Fax:
Practice Address - Street 1:404 ROUNDS DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1724
Practice Address - Country:US
Practice Address - Phone:810-208-0424
Practice Address - Fax:866-227-3775
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor