Provider Demographics
NPI:1679703466
Name:WAYNE CHIROPRACTIC, INC
Entity type:Organization
Organization Name:WAYNE CHIROPRACTIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANCELLOR
Authorized Official - Middle Name:P
Authorized Official - Last Name:WAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-344-2644
Mailing Address - Street 1:913 SAINT FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-1779
Mailing Address - Country:US
Mailing Address - Phone:573-888-8840
Mailing Address - Fax:
Practice Address - Street 1:400 W 4TH ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-2724
Practice Address - Country:US
Practice Address - Phone:870-857-8840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15697261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center