Provider Demographics
NPI:1700914397
Name:WEAVER, WILLIAM J (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:WEAVER
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 1:385 STATE ROUTE 18 STE F
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5703
Mailing Address - Country:US
Mailing Address - Phone:732-238-5420
Mailing Address - Fax:732-238-5421
Practice Address - Street 1:385 STATE ROUTE 18 STE F
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5703
Practice Address - Country:US
Practice Address - Phone:732-238-5420
Practice Address - Fax:732-238-5421
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00335200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ147234Medicare PIN