Provider Demographics
NPI:1891015673
Name:THE CHIROPRACTOR, DR WEATHERSBY, LLC
Entity Type:Organization
Organization Name:THE CHIROPRACTOR, DR WEATHERSBY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WEATHERSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-774-7557
Mailing Address - Street 1:1585 S PLAZA WAY STE 150
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7156
Mailing Address - Country:US
Mailing Address - Phone:928-774-7557
Mailing Address - Fax:928-774-8068
Practice Address - Street 1:1585 S PLAZA WAY STE 150
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7156
Practice Address - Country:US
Practice Address - Phone:928-774-7557
Practice Address - Fax:928-774-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty