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General NPI Number Information
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NPI Number | 1720054141
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Entity Type | Individual
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Provider Name | WAYNE ROBERT CARLSSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 60 W FAIRMOUNT AVE
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City | LAKEWOOD
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State | NY
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Zip | 14750-1723
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Country | US
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Telephone | 716-763-0949
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Fax | 716-763-0952
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Provider Business Mailing Address
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Address Line | 60 W FAIRMOUNT AVE
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City | LAKEWOOD
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State | NY
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Zip | 14750-1723
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Country | US
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Telephone | 716-763-0949
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Fax | 716-763-0952
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | X010927
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License Number State | NY
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