Provider Demographics
NPI:1982705620
Name:WEAKLEND, MATTHEW LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LOUIS
Last Name:WEAKLEND
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 1:18017 OAK ST STE A
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-6024
Mailing Address - Country:US
Mailing Address - Phone:402-697-7463
Mailing Address - Fax:402-614-5174
Practice Address - Street 1:18017 OAK ST STE A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-6024
Practice Address - Country:US
Practice Address - Phone:402-697-7463
Practice Address - Fax:402-892-1056
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09543OtherBLUE CROSS BLUE SHIELD
NE100252340Medicaid
NE278428Medicare ID - Type UnspecifiedMEDICARE