MEDICARE: DR. WAYNE PETER BULLEN 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	S03920	MD

General Provider Information

NPI Number	:	1942422753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE PETER BULLEN D.C.

Provider Business Mailing Address
First Line	:	11215 OAK LEAF DR
Second Line	:	1118
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-1317
Country	:	US
Telephone Number	:	202-210-9093
Fax Number	:	202-966-9380

Provider Business Practice Location Address
First Line	:	5530 WISCONSIN AVE STE 1248
Second Line	:
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-4301
Country	:	US
Telephone Number	:	202-966-9280
Fax Number	:	202-966-9380

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	05/01/2017

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