Provider Demographics
NPI:1306972237
Name:WEBER, KIRK WELDON (DC)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:WELDON
Last Name:WEBER
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 1:1808 ROUTE 422 EAST
Mailing Address - Street 2:
Mailing Address - City:FENELTON
Mailing Address - State:PA
Mailing Address - Zip Code:16034
Mailing Address - Country:US
Mailing Address - Phone:724-285-9093
Mailing Address - Fax:775-306-2216
Practice Address - Street 1:1808 ROUTE 422 EAST
Practice Address - Street 2:
Practice Address - City:FENELTON
Practice Address - State:PA
Practice Address - Zip Code:16034
Practice Address - Country:US
Practice Address - Phone:724-285-9093
Practice Address - Fax:775-306-2216
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002454-L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWE088728Medicare ID - Type Unspecified
PA25-1780930Medicare UPIN