Provider Demographics
NPI:1972576965
Name:WEISBEIN, BRUCE HOWARD (DC)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:HOWARD
Last Name:WEISBEIN
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 16TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-1434
Mailing Address - Country:US
Mailing Address - Phone:319-396-2300
Mailing Address - Fax:
Practice Address - Street 1:3221 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1434
Practice Address - Country:US
Practice Address - Phone:319-396-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0710944Medicaid
IAU67618Medicare UPIN
IA40987Medicare PIN