Provider Demographics
NPI:1295077071
Name:WEISMAN, EVAN THOMAS (DC)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:THOMAS
Last Name:WEISMAN
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 1:20300 VENTURA BLVD
Mailing Address - Street 2:245
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2448
Mailing Address - Country:US
Mailing Address - Phone:818-704-5121
Mailing Address - Fax:818-704-5847
Practice Address - Street 1:20300 VENTURA BLVD
Practice Address - Street 2:245
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2448
Practice Address - Country:US
Practice Address - Phone:818-704-5121
Practice Address - Fax:818-704-5847
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor