Healthcare Provider Details

I. General information

NPI: 1558923698
Provider Name (Legal Business Name): WEAVER CHIROPRACTIC WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 11/16/2024
Certification Date: 11/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 AIRWAY AVE STE F205
COSTA MESA CA
92626-4621
US

IV. Provider business mailing address

3151 AIRWAY AVE STE F205
COSTA MESA CA
92626-4621
US

V. Phone/Fax

Practice location:
  • Phone: 949-416-5429
  • Fax:
Mailing address:
  • Phone: 949-416-5429
  • Fax: 949-299-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELLE YUKA WEAVER
Title or Position: OWNER
Credential: DC, IBCLC
Phone: 949-228-9253