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General NPI Number Information
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NPI Number | 1437675733
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Entity Type | Organization
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Legal Business Name | WEINGARD WELLNESS LLC
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 3100 E HAWORTH AVE STE 260
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City | NEWBERG
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State | OR
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Zip | 97132-2197
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Country | US
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Telephone | 503-538-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 700 DEBORAH RD STE 270
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City | NEWBERG
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State | OR
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Zip | 97132-2270
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. TY WEINGARD
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Credential | DC
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Telephone | 253-691-4260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 5625
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License Number State | OR
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