MEDICARE: DR. WAYNE LESLIE CARTER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2806	CO

General Provider Information

NPI Number	:	1235215591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE LESLIE CARTER D.C.

Provider Business Mailing Address
First Line	:	2027 COLUMBIA LN
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81005-3279
Country	:	US
Telephone Number	:	719-566-1703
Fax Number	:

Provider Business Practice Location Address
First Line	:	2027 COLUMBIA LN
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81005-3279
Country	:	US
Telephone Number	:	719-566-1703
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2006
Last Update Date	:	07/08/2007

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