Provider Demographics
NPI:1164426581
Name:WEINGARTEN, MINDY A (D C)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:A
Last Name:WEINGARTEN
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 S CLYDE MORRIS BLVD
Mailing Address - Street 2:STE 1M
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-7453
Mailing Address - Country:US
Mailing Address - Phone:386-756-9303
Mailing Address - Fax:386-756-8119
Practice Address - Street 1:4606 S CLYDE MORRIS BLVD
Practice Address - Street 2:STE 1M
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-7453
Practice Address - Country:US
Practice Address - Phone:386-756-9303
Practice Address - Fax:386-756-8119
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHOOO4680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380727400Medicaid
FL22122OtherBC/BS PROVIDER NUMBER
FLP00118022OtherRAILROAD MEDICARE PIN
FLT84296Medicare UPIN
FLP00118022OtherRAILROAD MEDICARE PIN