Provider Demographics
NPI:1477622827
Name:CHIROPRACTIC SPORTS INSTITUTE A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHIROPRACTIC SPORTS INSTITUTE A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:WEYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-371-0737
Mailing Address - Street 1:2277 TOWNSGATE RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2415
Mailing Address - Country:US
Mailing Address - Phone:805-371-0737
Mailing Address - Fax:805-371-0735
Practice Address - Street 1:2277 TOWNSGATE RD
Practice Address - Street 2:SUITE #101
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2415
Practice Address - Country:US
Practice Address - Phone:805-371-0737
Practice Address - Fax:805-371-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20840111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20840Medicare PIN