Provider Demographics
NPI:1538387527
Name:DAVID J. WEBER CHIROPRACTIC OFFICE, INC., P.C.
Entity type:Organization
Organization Name:DAVID J. WEBER CHIROPRACTIC OFFICE, INC., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-747-6548
Mailing Address - Street 1:289 SINSINAWA AVE
Mailing Address - Street 2:
Mailing Address - City:EAST DUBUQUE
Mailing Address - State:IL
Mailing Address - Zip Code:61025-1220
Mailing Address - Country:US
Mailing Address - Phone:815-747-6548
Mailing Address - Fax:815-747-6549
Practice Address - Street 1:289 SINSINAWA AVE
Practice Address - Street 2:
Practice Address - City:EAST DUBUQUE
Practice Address - State:IL
Practice Address - Zip Code:61025-1220
Practice Address - Country:US
Practice Address - Phone:815-747-6548
Practice Address - Fax:815-747-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003755261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
T37447Medicare UPIN
IL646110Medicare ID - Type Unspecified