Healthcare Provider Details

I. General information

NPI: 1174524318
Provider Name (Legal Business Name): JOEL CHARLES WEISS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 10TH ST N
FARGO ND
58102-2502
US

IV. Provider business mailing address

1360 10TH ST N
FARGO ND
58102-2502
US

V. Phone/Fax

Practice location:
  • Phone: 701-237-5517
  • Fax: 701-237-3262
Mailing address:
  • Phone: 701-237-5517
  • Fax: 701-237-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number416
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: