Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | X006902-1 | NY |
NPI | 1376532523 |
---|---|
Provider Name | Dr. John Spencer Weyand |
First Address | Hornell, NY 14843-2213 |
Second Address | Hornell, NY 14843-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 04/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U27403 | (02) | NY |