Healthcare Provider Details

I. General information

NPI: 1265437040
Provider Name (Legal Business Name): GILBERT SETH WEINER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 CALLE HIPODROMO SUITE #101
SANTURCE PR
00907-3467
US

IV. Provider business mailing address

456B CENTRE ST
JAMAICA PLAIN MA
02130-1884
US

V. Phone/Fax

Practice location:
  • Phone: 787-783-3253
  • Fax:
Mailing address:
  • Phone: 787-783-3253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number242
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3146
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: