Healthcare Provider Details

I. General information

NPI: 1134127103
Provider Name (Legal Business Name): WAYNE M WHALEN D C A CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9570 CUYAMACA ST STE 101
SANTEE CA
92071-2690
US

IV. Provider business mailing address

9570 CUYAMACA ST STE 101
SANTEE CA
92071-2690
US

V. Phone/Fax

Practice location:
  • Phone: 619-258-1144
  • Fax: 619-258-6887
Mailing address:
  • Phone: 619-258-1144
  • Fax: 619-258-6887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC18999
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number18999
License Number StateCA

VIII. Authorized Official

Name: WAYNE MARTIN WHALEN
Title or Position: PRESIDENT
Credential: DC
Phone: 619-258-1144