Individual
JACLYN RENATA WEBER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2373 E BASELINE RD STE 100, GILBERT, AZ 85234-2477
(480) 497-0814
Mailing address
2373 E BASELINE RD STE 100, GILBERT, AZ 85234-2477
(480) 497-0814
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
8697
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8697
STATE LICENSE
AZ
Enumeration date
10/19/2018
Last updated
10/19/2018
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