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General NPI Number Information
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NPI Number | 1912911371
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Entity Type | Individual
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Provider Name | RICHARD J WEAVER DC
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 83 BANGOR JUNCTION ROAD BLUE VALLEY PLAZA
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City | BANGOR
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State | PA
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Zip | 18013
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Country | US
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Telephone | 610-588-7640
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Fax | 610-588-7114
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Provider Business Mailing Address
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Address Line | 331 S BROAD ST
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City | NAZARETH
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State | PA
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Zip | 18064
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Country | US
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Telephone | 610-393-1440
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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 | DC007215L
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License Number State | PA
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