Provider Demographics
NPI:1982613089
Name:WEATHERSBY, DALE (DC)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:WEATHERSBY
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 1:1507 BETTES ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1714
Mailing Address - Country:US
Mailing Address - Phone:936-756-5656
Mailing Address - Fax:
Practice Address - Street 1:1507 BETTES ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1714
Practice Address - Country:US
Practice Address - Phone:936-756-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609667Medicare PIN
TXT16511Medicare UPIN