Provider Demographics
NPI:1124235783
Name:WEAVER CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:WEAVER CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-342-2995
Mailing Address - Street 1:1100 STATE RD. 39 BY-PASS
Mailing Address - Street 2:SUITE #A
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151
Mailing Address - Country:US
Mailing Address - Phone:765-342-2995
Mailing Address - Fax:765-342-3011
Practice Address - Street 1:1100 STATE RD. 39 BY-PASS
Practice Address - Street 2:SUITE #A
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151
Practice Address - Country:US
Practice Address - Phone:765-342-2995
Practice Address - Fax:765-342-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6047830001Medicare NSC
IN147660Medicare PIN