MEDICARE: DR. VICTOR REED WAKEFIELD JR. DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0903	AL

General Provider Information

NPI Number	:	1588752968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR REED WAKEFIELD JR. DC

Provider Business Mailing Address
First Line	:	3322 MEMORIAL PKWY SW STE 617
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-5367
Country	:	US
Telephone Number	:	256-270-9993
Fax Number	:

Provider Business Practice Location Address
First Line	:	3322 MEMORIAL PKWY SW STE 617
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-5367
Country	:	US
Telephone Number	:	256-270-9993
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	03/07/2017

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