MEDICARE: BRETT RAY WEAVER DC

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	4345	OK

General Provider Information

NPI Number	:	1578109195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT RAY WEAVER DC

Provider Business Mailing Address
First Line	:	5416 N PORTLAND AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2072
Country	:	US
Telephone Number	:	405-724-8980
Fax Number	:

Provider Business Practice Location Address
First Line	:	5416 N PORTLAND AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2072
Country	:	US
Telephone Number	:	405-724-8980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	03/15/2024

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Directions to “ BRETT RAY WEAVER DC” Practice Location

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