Healthcare Provider Details

I. General information

NPI: 1750446407
Provider Name (Legal Business Name): DENNIS M WAZAC D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2006
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 BLUE RAVINE RD SUITE 200
FOLSOM CA
95630-3893
US

IV. Provider business mailing address

231 BLUE RAVINE RD SUITE 200
FOLSOM CA
95630-3893
US

V. Phone/Fax

Practice location:
  • Phone: 916-985-7575
  • Fax:
Mailing address:
  • Phone: 916-985-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberDC26511
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC26511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: