Provider Demographics
NPI:1114992559
Name:WEAVER, RYAN FRANK (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:FRANK
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 1:1970 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1002
Mailing Address - Country:US
Mailing Address - Phone:215-361-1122
Mailing Address - Fax:215-361-6037
Practice Address - Street 1:2026 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1004
Practice Address - Country:US
Practice Address - Phone:215-361-1122
Practice Address - Fax:215-361-6037
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007854L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0113820000OtherIBX / KHPE PROVIDER ID
PA133869OtherBC/BS PROVIDER ID
PA2672042OtherAETNA PROVIDER ID
PAP3257006OtherOXFORD PROVIDER ID
PA133869OtherBC/BS PROVIDER ID