Healthcare Provider Details

I. General information

NPI: 1689867871
Provider Name (Legal Business Name): MARTIN A WEISS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 MONTGOMERY BLVD.N.E.BLDG VLL
ALBUQUERQUE NM
87110-4604
US

IV. Provider business mailing address

9201 MONTGOMERY BLVD NE BLDG VLL
ALBUQUERQUE NM
87111-2468
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-7333
  • Fax: 505-296-5494
Mailing address:
  • Phone: 505-296-7333
  • Fax: 505-296-5494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number573
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: