Provider Demographics
NPI:1073884078
Name:WEAVER, ROURK THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:ROURK
Middle Name:THOMAS
Last Name:WEAVER
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 1:13605 W MAPLE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-8759
Mailing Address - Country:US
Mailing Address - Phone:316-721-2220
Mailing Address - Fax:316-721-2226
Practice Address - Street 1:13605 W MAPLE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-8759
Practice Address - Country:US
Practice Address - Phone:316-721-2220
Practice Address - Fax:316-721-2226
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012000070111N00000X
KS01-05557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor