Provider Demographics
NPI:1700966694
Name:WEISS, ELIZABETH MARY (DC, LICAC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARY
Last Name:WEISS
Suffix:
Gender:F
Credentials:DC, LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 PECHIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-5023
Mailing Address - Country:US
Mailing Address - Phone:215-483-3661
Mailing Address - Fax:215-483-3671
Practice Address - Street 1:4245 PECHIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-5023
Practice Address - Country:US
Practice Address - Phone:215-483-3661
Practice Address - Fax:215-483-3671
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002222L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWE150015Medicare ID - Type UnspecifiedCHIROPRACTOR