Provider Demographics
NPI:1659677797
Name:WESTON CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:WESTON CHIROPRACTIC, P.A.
Other - Org Name:WESTON FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-384-2925
Mailing Address - Street 1:1398 SW 160TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1992
Mailing Address - Country:US
Mailing Address - Phone:954-384-2925
Mailing Address - Fax:954-384-2915
Practice Address - Street 1:1398 SW 160TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326-1992
Practice Address - Country:US
Practice Address - Phone:954-384-2925
Practice Address - Fax:954-384-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6685170001Medicare NSC