=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144917246
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 100 CHIRO WEEKS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2023
-----------------------------------------------------
Last Update Date | 04/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22610 US HIGHWAY 281 N STE 102
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-7561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-502-3548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 394 OAK HARBOR TRL
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30066-6123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LEAD DOCTOR/OWNER
-----------------------------------------------------
Name | NATHANIEL WEEKS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 937-303-2415
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------