Provider Demographics
NPI:1811915606
Name:WEITEKAMPER, MAGNUS (DC)
Entity type:Individual
Prefix:DR
First Name:MAGNUS
Middle Name:
Last Name:WEITEKAMPER
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 1:23 PLANTATION PARK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6038
Mailing Address - Country:US
Mailing Address - Phone:843-757-9950
Mailing Address - Fax:843-757-8058
Practice Address - Street 1:23 PLANTATION PARK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6038
Practice Address - Country:US
Practice Address - Phone:843-757-9950
Practice Address - Fax:843-757-8058
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2505111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician