Healthcare Provider Details

I. General information

NPI: 1053272260
Provider Name (Legal Business Name): SPENCER W WEYAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PARK DR
HORNELL NY
14843-2213
US

IV. Provider business mailing address

20 PARK DR
HORNELL NY
14843-2213
US

V. Phone/Fax

Practice location:
  • Phone: 607-324-7246
  • Fax: 607-324-7249
Mailing address:
  • Phone: 607-324-7246
  • Fax: 607-324-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number014029
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: