Provider Demographics
NPI:1316903958
Name:WEISBROD, WARREN WESLEY (DC)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:WESLEY
Last Name:WEISBROD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MRS
Other - First Name:MINDY
Other - Middle Name:JEWELL
Other - Last Name:WEISBROD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:401 N ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4368
Mailing Address - Country:US
Mailing Address - Phone:480-821-0101
Mailing Address - Fax:480-821-5147
Practice Address - Street 1:401 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4368
Practice Address - Country:US
Practice Address - Phone:480-821-0101
Practice Address - Fax:480-821-5147
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC4299111N00000X, 111NR0200X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0246560OtherBCBSAZ
AZ0246560OtherBCBSAZ
AZ27130Medicare ID - Type Unspecified