Provider Demographics
NPI:1922280791
Name:WEAVER CHIROPRACTIC INC
Entity Type:Organization
Organization Name:WEAVER CHIROPRACTIC INC
Other - Org Name:ENTERPRISE BACK CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-223-0583
Mailing Address - Street 1:3051 VICTOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002
Mailing Address - Country:US
Mailing Address - Phone:530-223-0583
Mailing Address - Fax:530-223-6316
Practice Address - Street 1:3051 VICTOR AVENUE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002
Practice Address - Country:US
Practice Address - Phone:530-223-0583
Practice Address - Fax:530-223-6316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10695111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
411541944369OtherACN
10973137OtherCAQH
DC0106950Medicare Oscar/Certification
411541944369OtherACN