MEDICARE: DR. SCOTT WEAVER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4274	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	NC6179A	OTHER	NC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417216839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT WEAVER D.C.

Provider Business Mailing Address
First Line	:	PO BOX 13647
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27415-3647
Country	:	US
Telephone Number	:	336-763-3756
Fax Number	:	336-763-3757

Provider Business Practice Location Address
First Line	:	3150 N ELM ST
Second Line	:	SUITE 103
City	:	GREENSBORO
State	:	NC
Zip	:	27408-3880
Country	:	US
Telephone Number	:	336-763-3756
Fax Number	:	336-763-3757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	02/24/2014

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Directions to “ DR. SCOTT WEAVER D.C.” Practice Location

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