Provider Demographics
NPI:1639616436
Name:WEAVER, ERIN ELIZABETH (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:ELIZABETH
Last Name:WEAVER
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-1301
Mailing Address - Country:US
Mailing Address - Phone:541-269-9878
Mailing Address - Fax:877-349-1128
Practice Address - Street 1:519 S 7TH ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1301
Practice Address - Country:US
Practice Address - Phone:541-269-9878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC196824171100000X
OR4057175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500737989Medicaid