Provider Demographics
NPI:1871589564
Name:WEBER, MARK C (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:WEBER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W 10TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-1443
Mailing Address - Country:US
Mailing Address - Phone:814-454-0572
Mailing Address - Fax:814-459-1157
Practice Address - Street 1:350 W 10TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1443
Practice Address - Country:US
Practice Address - Phone:814-454-0572
Practice Address - Fax:814-459-1157
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003184L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA117602OtherBLUE SHIELD