Provider Demographics
NPI:1619290806
Name:WEAVER, NATHAN WOODZELL (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:WOODZELL
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 1:3410 W WENDOVER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1585
Mailing Address - Country:US
Mailing Address - Phone:336-274-3500
Mailing Address - Fax:336-292-1928
Practice Address - Street 1:3410 W WENDOVER AVE STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1585
Practice Address - Country:US
Practice Address - Phone:336-274-3500
Practice Address - Fax:336-292-1928
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor