Provider Demographics
NPI:1215155429
Name:WEYMAN, TERRY LEO (DC)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LEO
Last Name:WEYMAN
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 1:2277 TOWNSGATE RD
Mailing Address - Street 2:#101
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2415
Mailing Address - Country:US
Mailing Address - Phone:805-371-0737
Mailing Address - Fax:805-371-0735
Practice Address - Street 1:2277 TOWNSGATE RD
Practice Address - Street 2:#101
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2415
Practice Address - Country:US
Practice Address - Phone:805-371-0737
Practice Address - Fax:805-371-0735
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20840111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20840Medicare PIN