Provider Demographics
NPI:1336169184
Name:WEIDNER, ALAN DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DOUGLAS
Last Name:WEIDNER
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 1:2232 W 5400 S
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84118-1744
Mailing Address - Country:US
Mailing Address - Phone:801-969-9001
Mailing Address - Fax:801-969-7305
Practice Address - Street 1:2232 W 5400 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84118-1744
Practice Address - Country:US
Practice Address - Phone:801-969-9001
Practice Address - Fax:801-969-7305
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT921761801202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor