Provider Demographics
NPI:1902934391
Name:WEAVER, DAVID S (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:WEAVER
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 1:115 MCNARY ESTATES DR N
Mailing Address - Street 2:STE E.
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-7492
Mailing Address - Country:US
Mailing Address - Phone:503-390-5552
Mailing Address - Fax:503-390-5994
Practice Address - Street 1:115 MCNARY ESTATES DR N
Practice Address - Street 2:STE E.
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-7492
Practice Address - Country:US
Practice Address - Phone:503-390-5552
Practice Address - Fax:503-390-5994
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
100426Medicare ID - Type Unspecified