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General NPI Number Information
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NPI Number | 1679703466
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Entity Type | Organization
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Legal Business Name | WAYNE CHIROPRACTIC, INC
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 400 W 4TH ST
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City | CORNING
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State | AR
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Zip | 72422-2724
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Country | US
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Telephone | 870-857-8840
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Fax |
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Provider Business Mailing Address
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Address Line | 913 SAINT FRANCIS ST
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City | KENNETT
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State | MO
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Zip | 63857-1779
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Country | US
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Telephone | 573-888-8840
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. CHANCELLOR P WAYNE
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Credential | D.C.
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Telephone | 573-344-2644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 15697
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License Number State | AR
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