Physician Compare National (NPI:1801287222)

HEALTHCARE PROVIDER: BRANDON WEAVER D.C.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1801287222
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2860719390
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150323000643
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WEAVER
	Individual professional last name
Provider First Name	BRANDON
	Individual professional first name
Provider Middle Name	JOHN
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WESTERN STATES COLLEGE OF CHIROPRACTIC
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	LAKESHORE CHIROPRACTIC AND SPORTS REHABILITATION PLLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	1658624937
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1302 BRIDGE ST
	Group Practice or individual's line 1 address
City	CHARLEVOIX
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	497201608
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2312370665
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y