Healthcare Provider Details

I. General information

NPI: 1205160694
Provider Name (Legal Business Name): WEAVER CHIROPRACTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 BANGOR JUNCTION RD
BANGOR PA
18013-9314
US

IV. Provider business mailing address

83 BANGOR JUNCTION ROAD
BANGOR PA
18013
US

V. Phone/Fax

Practice location:
  • Phone: 610-588-7640
  • Fax:
Mailing address:
  • Phone: 610-588-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: RICHARD J WEAVER
Title or Position: OWNER
Credential: DC
Phone: 610-588-7640