Individual
ALEC WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5469 CALEN LN, CHUBBUCK, ID 83202-5099
(208) 313-6913
Mailing address
5469 CALEN LN, CHUBBUCK, ID 83202-5099
(208) 313-6913
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2018
Last updated
03/26/2018
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