Provider Demographics
NPI:1548273048
Name:WEBER, DOUG (DC)
Entity type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:WEBER
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 1:6300 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2028
Mailing Address - Country:US
Mailing Address - Phone:321-259-0090
Mailing Address - Fax:321-259-0089
Practice Address - Street 1:6300 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2028
Practice Address - Country:US
Practice Address - Phone:321-259-0090
Practice Address - Fax:321-259-0089
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55615Medicare ID - Type Unspecified