Provider Demographics
NPI:1174702732
Name:WEAVER, MICHAEL PAUL (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
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 1:1130 S CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4036
Mailing Address - Country:US
Mailing Address - Phone:330-799-1110
Mailing Address - Fax:330-799-1254
Practice Address - Street 1:1130 S CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4036
Practice Address - Country:US
Practice Address - Phone:330-799-1110
Practice Address - Fax:330-799-1254
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2055725Medicaid