Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 1037 | SC |
N | 111NS0005X | Chiropractic Sports Physician | 1037 | SC |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 1037 | SC |
NPI | 1154482537 |
---|---|
Provider Name | Dr. Gary S Weaver |
First Address | Columbia, SC 29223-4308 |
Second Address | Columbia, SC 29223-4308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |