Individual
DR. JACKIE LYNN WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC, PHARM D
Contact information
Practice address
2726 W GENTRY PKWY, TYLER, TX 75702-1635
(903) 593-2533
(903) 593-2555
Mailing address
2726 W GENTRY PKWY, TYLER, TX 75702-1635
(903) 593-2533
(903) 593-2555
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6129 DC
TX
183500000X
Pharmacist
48560
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001665101
—
TX
01
—
8K1680
BLUE CROSS
—
Enumeration date
09/07/2005
Last updated
01/19/2017
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