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Individual
KENNETH ROBERT WEIL
Active
Individual
KENNETH ROBERT WEIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5608
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35ZCDQP
MEDICARE
GA
01
—
672394
BLUE CROSS BLUE SHIELD #
GA
Enumeration date
06/30/2006
Last updated
10/25/2010
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