Provider Demographics
NPI:1942743828
Name:WEAVER, RYAN E (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:E
Last Name:WEAVER
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 1:801 POLARIS PKWY APT 409
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-2409
Mailing Address - Country:US
Mailing Address - Phone:740-607-9272
Mailing Address - Fax:
Practice Address - Street 1:801 POLARIS PKWY APT 409
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-2409
Practice Address - Country:US
Practice Address - Phone:740-607-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor