Provider Demographics
NPI:1295725695
Name:WEYMOUTH, ALAN WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:WILLIAM
Last Name:WEYMOUTH
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 1:194 BEECHLAND RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2536
Mailing Address - Country:US
Mailing Address - Phone:207-667-3001
Mailing Address - Fax:207-667-4501
Practice Address - Street 1:194 BEECHLAND RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2536
Practice Address - Country:US
Practice Address - Phone:207-667-3001
Practice Address - Fax:207-667-4501
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME005795OtherANTHEM BC/BS
ME111700000Medicaid
ME10904039OtherCAQH
ME111700000Medicaid
ME005795OtherANTHEM BC/BS