Basic Information
| Provider Information | |||||||||
| NPI: | 1033604277 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEILAND | ||||||||
| FirstName: | CHELSEA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2627 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322044712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043087372 | ||||||||
| FaxNumber: | 9043082908 | ||||||||
| Practice Location | |||||||||
| Address1: | 6767 29TH ST | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806345474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706522801 | ||||||||
| FaxNumber: | 9706522827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2018 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DR.0066031 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | UO5882 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.