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General NPI Number Information
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NPI Number | 1215443973
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Entity Type | Organization
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Legal Business Name | WAYNE CARR CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 12/18/2017
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Provider Practice Location Address
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Address Line | 711 HEALDSBURG AVE
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City | HEALDSBURG
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State | CA
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Zip | 95448-3671
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Country | US
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Telephone | 707-431-7255
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Fax | 707-431-7256
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Provider Business Mailing Address
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Address Line | 711 HEALDSBURG AVE
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City | HEALDSBURG
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State | CA
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Zip | 95448-3671
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Country | US
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Telephone | 707-431-7255
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Fax | 707-431-7256
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Authorized Official
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Title or Position | CEO
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Name | DR. WAYNE SCOTT CARR
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Credential | DC
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Telephone | 707-431-7255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 19403
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License Number State | CA
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