Provider Demographics
NPI:1821870130
Name:MCDERMOTT, WESTON (DC)
Entity Type:Individual
Prefix:DR
First Name:WESTON
Middle Name:
Last Name:MCDERMOTT
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 1:18933 E SAN TAN BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-2001
Mailing Address - Country:US
Mailing Address - Phone:480-447-2433
Mailing Address - Fax:
Practice Address - Street 1:18933 E SAN TAN BLVD STE 125
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-2001
Practice Address - Country:US
Practice Address - Phone:480-447-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor