Provider Demographics
NPI:1174524318
Name:WEISS, JOEL CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:CHARLES
Last Name:WEISS
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 1:1360 10TH ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2502
Mailing Address - Country:US
Mailing Address - Phone:701-237-5517
Mailing Address - Fax:701-237-3262
Practice Address - Street 1:1360 10TH ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2502
Practice Address - Country:US
Practice Address - Phone:701-237-5517
Practice Address - Fax:701-237-3262
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND416111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14045Medicaid
ND4308OtherND BLUE CROSS/BLUE SHIELD
MN8Z158WEOtherMN BLUE CROSS/BLUE SHIELD
N4308Medicare ID - Type Unspecified
MN8Z158WEOtherMN BLUE CROSS/BLUE SHIELD