1114227063 NPI number — WEISS CHIROPRACTIC LIFE CENTER PLC

Table of content: (NPI 1114227063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114227063 NPI number — WEISS CHIROPRACTIC LIFE CENTER PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEISS CHIROPRACTIC LIFE CENTER PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WEISS CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114227063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44170 W. 12 MILE RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-624-9393
Provider Business Mailing Address Fax Number:
248-624-6010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44170 W. 12 MILE RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-624-9393
Provider Business Practice Location Address Fax Number:
248-773-8740
Provider Enumeration Date:
10/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WEISS
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-624-9393

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301007148 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P99468 . This is a "BCN PROVIDER #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3495449 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95035449 . This is a "BCBS PROVIDER #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0M69020 . This is a "MEDICARE ID- TYPE UNSPECIFIED" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 168901 . This is a "SELECTCARE PROVIDER #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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