MEDICARE: WEBER FAMILY CHIROPRACTIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1538119888	OTHER	IL	NATIONAL GOVERNMENT SERVICES

General Provider Information

NPI Number	:	1801841648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEBER FAMILY CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	1807 W LAFAYETTE AVE
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-1008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 W LAFAYETTE AVE
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-1008
Country	:	US
Telephone Number	:	217-243-5438
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT WEBER
Credential	:	D. C.
Telephone Number	:	217-243-5438

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/11/2014

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