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General NPI Number Information
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NPI Number | 1164102406
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Entity Type | Individual
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Provider Name | WESTON DEHAVEN DC
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Gender | Male
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Dates
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Enumeration Date | 07/21/2023
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 7652 RED ARROW HWY
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City | WATERVLIET
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State | MI
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Zip | 49098-9396
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Country | US
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Telephone | 269-463-4100
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Fax | 269-463-4100
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Provider Business Mailing Address
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Address Line | PO BOX 245
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City | WATERVLIET
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State | MI
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Zip | 49098-0245
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Country | US
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Telephone | 269-463-4100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301401441
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License Number State | MI
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