Provider Demographics
NPI:1962623124
Name:WEISS, MICHAEL MARK (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MARK
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 1:450 N PARK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6917
Mailing Address - Country:US
Mailing Address - Phone:954-986-4559
Mailing Address - Fax:
Practice Address - Street 1:450 N PARK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6917
Practice Address - Country:US
Practice Address - Phone:954-986-4559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3523111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88565OtherBLUE CROSS BLUE SHIELD FL