Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC4299 | AZ |
N | 111NR0200X | Radiology | DC4299 | AZ |
N | 213ER0200X | Radiology | DC4299 | AZ |
N | 111NS0005X | Chiropractic Sports Physician | DC4299 | AZ |
NPI | 1316903958 |
---|---|
Provider Name | Dr. Warren Wesley Weisbrod |
First Address | Chandler, AZ 85224-4368 |
Second Address | Chandler, AZ 85224-4368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2006 |
Last Update Date | 16/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0246560 | BCBSAZ (01) | AZ |
U29138 | (02) | AZ |