Provider Demographics
NPI:1376671818
Name:WEBER, CONSTANCE STEPHANIE (DC)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:STEPHANIE
Last Name:WEBER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1816
Mailing Address - Country:US
Mailing Address - Phone:415-541-5678
Mailing Address - Fax:
Practice Address - Street 1:198 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1816
Practice Address - Country:US
Practice Address - Phone:415-541-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor