MEDICARE: DR. WAYNE EDWARD PRATT 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	2677	MN

General Provider Information

NPI Number	:	1255337408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE EDWARD PRATT D.C.

Provider Business Mailing Address
First Line	:	13750 CROSSTOWN DR NW
Second Line	:	SUITE L102
City	:	ANDOVER
State	:	MN
Zip	:	55304-5853
Country	:	US
Telephone Number	:	763-767-1800
Fax Number	:	763-767-1818

Provider Business Practice Location Address
First Line	:	13750 CROSSTOWN DR NW
Second Line	:	SUITE L102
City	:	ANDOVER
State	:	MN
Zip	:	55304-5853
Country	:	US
Telephone Number	:	763-767-1800
Fax Number	:	763-767-1818

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/18/2007

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