Provider Demographics
NPI:1770868598
Name:WEIR, DUSTIN WADE (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:WADE
Last Name:WEIR
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 1:1108 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-7226
Mailing Address - Country:US
Mailing Address - Phone:972-242-6886
Mailing Address - Fax:972-242-7886
Practice Address - Street 1:1108 S ELM ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-7226
Practice Address - Country:US
Practice Address - Phone:972-242-6886
Practice Address - Fax:972-242-7886
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor