Provider Demographics
NPI:1285706283
Name:WEATHERSBY, BRIAN SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SCOTT
Last Name:WEATHERSBY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1585 S PLAZA WAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7156
Mailing Address - Country:US
Mailing Address - Phone:928-774-7557
Mailing Address - Fax:928-774-7557
Practice Address - Street 1:1585 S PLAZA WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7156
Practice Address - Country:US
Practice Address - Phone:928-774-7557
Practice Address - Fax:928-774-7557
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ7442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor