Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Mallory Weaver, DO

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1376235861

Dr. Mallory Weaver, DO is a Family Practice in Peoria, Illinois. Graduated from At Still Un of Hlth Sciences, Col of Osteo Med, Mesa in 2023, 3 years ago. Practices as a sole proprietor.

Years since qualifying
3
Trained at
At Still Un of Hlth Sciences, Col of Osteo Med, Mesa
In the registry since
2023
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

815 Main St Ste C
Peoria, IL 61602-1080
Phone: (309) 672-4977
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X · Licence 90200000X

Record details

NPI number1376235861
Entity typeIndividual (Type 1)
GenderFemale
Credentials DO
Sole proprietorYes
NPI enumeratedMay 23, 2023
Last updated in NPPESMay 23, 2023
Certification dateMay 23, 2023
Mailing address1179 N Bluff Lake Dr, East Peoria, IL 61611-1281

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolAT STILL UN OF HLTH SCIENCES, COL OF OSTEO MED, MESA
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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