Jackie Lynn Weaver, DC, PHARM D

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

6129 DC Issued in TX

Practice address

2726 W Gentry Pkwy
Tyler, TX 75702-1635

Phone

(903) 593-2533

Fax

(903) 593-2555

NPI assigned

Sep 7, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• After Hours Therapy PC

  • Physical Therapy Clinic/Center
  • Tyler, TX
  • NPI 1750374187
  NPD (past) Authorized official
• Woody Weaver Pharmacy Inc

  • Community/Retail Pharmacy
  • Tyler, TX
  • NPI 1033109053
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484784000000",
    "number": "1720072523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2726 W GENTRY PKWY",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757021635",
            "telephone_number": "903-593-2533",
            "fax_number": "903-593-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2726 W GENTRY PKWY",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757021635",
            "telephone_number": "903-593-2533",
            "fax_number": "903-593-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "JACKIE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DC, PHARM D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-07",
        "last_updated": "2017-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "6129 DC",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "48560",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001665101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8K1680",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wayne D Wayt, PAC
• Baileigh Weatherford
• Taylor Brown Weathers, RN
• Ava N. Weaver, M.S, NCC,LPC
• Hanna Weaver
• Martha Jean Weaver
• Rachel Elizabeth Weaver
• Zana Webber
• Ansel Weber, MD
• Jill Weber

• Chiropractor in Tyler, TX
• Providers in Tyler, TX by specialty
• Chiropractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.