Healthcare Provider Details

I. General information

NPI: 1568797504
Provider Name (Legal Business Name): WEBER CHIROPRACTIC CLINIC, INC. P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 TIETON DR
YAKIMA WA
98902-3666
US

IV. Provider business mailing address

3802 TIETON DR
YAKIMA WA
98902-3666
US

V. Phone/Fax

Practice location:
  • Phone: 509-965-7155
  • Fax: 509-965-0730
Mailing address:
  • Phone: 509-965-7155
  • Fax: 509-965-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0002528
License Number StateWA

VIII. Authorized Official

Name: DR. EUGENE CARL WEBER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 509-965-7155