Provider Demographics
NPI:1750651808
Name:WEIGAND, CORTNEY SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:CORTNEY
Middle Name:SUE
Last Name:WEIGAND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 W MAYPOLE AVE
Mailing Address - Street 2:302
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2688
Mailing Address - Country:US
Mailing Address - Phone:330-687-6309
Mailing Address - Fax:
Practice Address - Street 1:229 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3047
Practice Address - Country:US
Practice Address - Phone:630-447-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor