Provider Demographics
NPI:1659802890
Name:SQUIRES, WESTON L (DC)
Entity Type:Individual
Prefix:DR
First Name:WESTON
Middle Name:L
Last Name:SQUIRES
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 1:414 W US HIGHWAY 10 31
Mailing Address - Street 2:
Mailing Address - City:SCOTTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49454-9274
Mailing Address - Country:US
Mailing Address - Phone:231-757-3356
Mailing Address - Fax:231-757-4640
Practice Address - Street 1:414 W US HIGHWAY 10 31
Practice Address - Street 2:
Practice Address - City:SCOTTVILLE
Practice Address - State:MI
Practice Address - Zip Code:49454-9274
Practice Address - Country:US
Practice Address - Phone:231-757-3356
Practice Address - Fax:231-757-4640
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111N00000XMedicaid
MI111N00000XMedicare PIN
MI111N00000XMedicare Oscar/Certification
MI111N00000XMedicaid