MEDICARE: CHIROPRACTIC SPORTS INSTITUTE A PROFESSIONAL CORPORATION

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	111NS0005X	Sports Physician Chiropractor	20840	CA

General Provider Information

NPI Number	:	1477622827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC SPORTS INSTITUTE A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2277 TOWNSGATE RD
Second Line	:	SUITE #101
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-2415
Country	:	US
Telephone Number	:	805-371-0737
Fax Number	:	805-371-0735

Provider Business Practice Location Address
First Line	:	2277 TOWNSGATE RD
Second Line	:	SUITE #101
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-2415
Country	:	US
Telephone Number	:	805-371-0737
Fax Number	:	805-371-0735

Authorized Official
Title or Position	:	PRESIDENT OWNER CHIROPRACTOR
Name	:	DR. TERRY LEO WEYMAN
Credential	:	DC
Telephone Number	:	805-371-0737

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	09/13/2010

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