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General NPI Number Information
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NPI Number | 1831645688
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Entity Type | Organization
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Legal Business Name | MICHELLE WEAVER
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 1341 SAN JUAN STREET APT G3
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City | TUSTIN
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State | CA
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Zip | 92780
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Country | US
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Telephone | 949-892-8868
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Fax |
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Provider Business Mailing Address
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Address Line | 1341 SAN JUAN ST APT G3
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City | TUSTIN
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State | CA
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Zip | 92780-7828
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Country | US
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Telephone | 949-892-8868
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MICHELLE YUKA WEAVER
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Credential | D.C.
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Telephone | 949-892-8868
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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 | 33650
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License Number State | CA
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