Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC 29672 | CA |
NPI | 1003071986 |
---|---|
Provider Name | Dr. Scott Weidley |
First Address | San Francisco, CA 94123-4102 |
Second Address | San Francisco, CA 94123-4102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2008 |
Last Update Date | 21/07/2008 |