Healthcare Provider Details

I. General information

NPI: 1659677797
Provider Name (Legal Business Name): WESTON CHIROPRACTIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1398 SW 160TH AVE SUITE 102
SUNRISE FL
33326-1992
US

IV. Provider business mailing address

1398 SW 160TH AVE SUITE 102
SUNRISE FL
33326-1992
US

V. Phone/Fax

Practice location:
  • Phone: 954-384-2925
  • Fax: 954-384-2915
Mailing address:
  • Phone: 954-384-2925
  • Fax: 954-384-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: STEVEN D GOODMAN
Title or Position: OWNER
Credential: D.C.
Phone: 954-384-2925