Provider Demographics
NPI:1205160694
Name:WEAVER CHIROPRACTIC CENTER, LLC
Entity type:Organization
Organization Name:WEAVER CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-588-7640
Mailing Address - Street 1:83 BANGOR JUNCTION ROAD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013
Mailing Address - Country:US
Mailing Address - Phone:610-588-7640
Mailing Address - Fax:
Practice Address - Street 1:83 BANGOR JUNCTION RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-9314
Practice Address - Country:US
Practice Address - Phone:610-588-7640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty