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General NPI Number Information
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NPI Number | 1124504840
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Entity Type | Individual
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Provider Name | MICHAEL JACOB WEISS DC
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Gender | Male
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 404 ROUNDS DR
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City | FENTON
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State | MI
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Zip | 48430-1724
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Country | US
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Telephone | 810-208-0424
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Fax | 866-227-3775
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Provider Business Mailing Address
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Address Line | 12087 CHURCH ST
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City | BIRCH RUN
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State | MI
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Zip | 48415-8758
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Country | US
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Telephone | 989-860-8972
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301010627
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License Number State | MI
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