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General NPI Number Information
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NPI Number | 1407101140
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Entity Type | Organization
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Legal Business Name | WEATHERS CHIROPRACTIC CENTER PLLC
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 128 WEST BROKEN ST
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City | LIBERTY
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State | MS
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Zip | 39645
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Country | US
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Telephone | 601-657-0364
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Fax | 601-657-8851
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Provider Business Mailing Address
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Address Line | 250 S BROAD ST
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City | LIBERTY
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State | MS
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Zip | 39645-8029
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Country | US
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Telephone | 601-657-0364
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Fax | 601-657-8851
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRADFORD KIMBALL WEATHERS
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Credential | DC
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Telephone | 601-657-0364
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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 | 1192
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License Number State | MS
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