Healthcare Provider Details

I. General information

NPI: 1285086538
Provider Name (Legal Business Name): CHLOE WEBER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 WINDSOR PL
BROOKLYN NY
11215-5918
US

IV. Provider business mailing address

234 WINDSOR PL
BROOKLYN NY
11215-5918
US

V. Phone/Fax

Practice location:
  • Phone: 347-400-6773
  • Fax:
Mailing address:
  • Phone: 347-400-6773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number005744-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: