Provider Demographics
NPI:1912473224
Name:WEISS, BENJAMIN DYLAN (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DYLAN
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 1:6744 N GLENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1926
Mailing Address - Country:US
Mailing Address - Phone:208-748-5909
Mailing Address - Fax:208-561-8877
Practice Address - Street 1:6744 N GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-1926
Practice Address - Country:US
Practice Address - Phone:208-748-5909
Practice Address - Fax:208-561-8877
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1945111N00000X
VA0104557516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor