Provider Demographics
NPI:1255534269
Name:WEAVER-RATKOVIC CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:WEAVER-RATKOVIC CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-981-5666
Mailing Address - Street 1:60 E. FOOTHILL BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3984
Mailing Address - Country:US
Mailing Address - Phone:909-981-5666
Mailing Address - Fax:909-949-2316
Practice Address - Street 1:60 E. FOOTHILL BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3984
Practice Address - Country:US
Practice Address - Phone:909-981-5666
Practice Address - Fax:909-949-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0252850Medicare ID - Type Unspecified