Provider Demographics
NPI:1619156494
Name:BRUCE A WEARY DC LTD
Entity Type:Organization
Organization Name:BRUCE A WEARY DC LTD
Other - Org Name:WEARY CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-778-2227
Mailing Address - Street 1:980 WILLOW CREEK ROAD
Mailing Address - Street 2:104
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:928-778-2227
Mailing Address - Fax:928-771-9159
Practice Address - Street 1:980 WILLOW CREEK ROAD
Practice Address - Street 2:104
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-778-2227
Practice Address - Fax:928-771-9159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ3936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty