Healthcare Provider Details

I. General information

NPI: 1255481354
Provider Name (Legal Business Name): LYNN R WEETER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 HIGHWAY 365 STE D
MAYFLOWER AR
72106-8406
US

IV. Provider business mailing address

PO BOX 11234
CONWAY AR
72034-0022
US

V. Phone/Fax

Practice location:
  • Phone: 817-236-7565
  • Fax:
Mailing address:
  • Phone: 817-247-2853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12402
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: