Provider Demographics
NPI:1043480825
Name:WEATHERWAX, ROBERT SIDNEY (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SIDNEY
Last Name:WEATHERWAX
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 SABAL PALM DRIVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2558
Mailing Address - Country:US
Mailing Address - Phone:407-786-7246
Mailing Address - Fax:407-786-8861
Practice Address - Street 1:159 SABAL PALM DRIVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2558
Practice Address - Country:US
Practice Address - Phone:407-786-7246
Practice Address - Fax:407-786-8861
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor