Healthcare Provider Details

I. General information

NPI: 1720032188
Provider Name (Legal Business Name): WAYNE FRANKLIN KIRK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 WASHINGTON AVE.
EVANSVILLE IN
47714-2349
US

IV. Provider business mailing address

2333 WASHINGTON AVE.
EVANSVILLE IN
47714-2349
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-5201
  • Fax: 812-477-5293
Mailing address:
  • Phone: 812-477-5201
  • Fax: 812-477-5293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001920A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: