Provider Demographics
NPI:1629197991
Name:WEAVER, JAMES CLINTON (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLINTON
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 1:1100 STATE RD. 39 BY-PASS
Mailing Address - Street 2:SUITE #A
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151
Mailing Address - Country:US
Mailing Address - Phone:765-342-2995
Mailing Address - Fax:765-342-3011
Practice Address - Street 1:1100 STATE ROAS 39 BY-PASS
Practice Address - Street 2:#A
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151
Practice Address - Country:US
Practice Address - Phone:765-342-2995
Practice Address - Fax:765-342-3011
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001876A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN147660Medicare PIN