MEDICARE: DR. LEON PATRICK WEATHERSBY JR. 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	22887	CA

General Provider Information

NPI Number	:	1417397159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEON PATRICK WEATHERSBY JR. D.C.

Provider Business Mailing Address
First Line	:	8255 VINEYARD AVE
Second Line	:	1100H
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-3375
Country	:	US
Telephone Number	:	310-838-1600
Fax Number	:	310-453-1363

Provider Business Practice Location Address
First Line	:	9225 VENICE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-3324
Country	:	US
Telephone Number	:	310-838-1600
Fax Number	:	310-453-1363

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	06/26/2013

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