Provider Demographics
NPI:1255481354
Name:WEETER, LYNN R (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:R
Last Name:WEETER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 BOAT CLUB RD STE 150
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3631
Mailing Address - Country:US
Mailing Address - Phone:817-236-7565
Mailing Address - Fax:
Practice Address - Street 1:8101 BOAT CLUB RD STE 150
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-3631
Practice Address - Country:US
Practice Address - Phone:817-236-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU94311Medicare UPIN
TX8A4785Medicare ID - Type Unspecified