1477522688 NPI number — DR. CRAIG WILLIAM WEISMANTEL D.C.

Table of content: DR. CRAIG WILLIAM WEISMANTEL D.C. (NPI 1477522688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477522688 NPI number — DR. CRAIG WILLIAM WEISMANTEL D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISMANTEL
Provider First Name:
CRAIG
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1477522688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 497
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OTTSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18942-0497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-536-4333
Provider Business Mailing Address Fax Number:
215-536-5030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 JUNIPER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUAKERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18951-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-536-4333
Provider Business Practice Location Address Fax Number:
215-536-5030
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC8644 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3325819 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: AJ008574 . This is a "ADJUNCTIVE PROCEDURES" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2010534000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 664536 . This is a "ACN GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2010534000 . This is a "KEYSTONE AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001317223 . This is a "HIGHMARK BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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