Provider Demographics
NPI:1720015134
Name:WEINMAN, WILLIAM GREG (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GREG
Last Name:WEINMAN
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 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-2786
Mailing Address - Country:US
Mailing Address - Phone:309-698-2500
Mailing Address - Fax:
Practice Address - Street 1:1100 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-2786
Practice Address - Country:US
Practice Address - Phone:309-698-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038010333Medicaid
IL038010333Medicaid