Provider Demographics
NPI:1093771255
Name:LANEY, WAYNE GORDON (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:GORDON
Last Name:LANEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 BRUSHY CREEK RD STE C-2
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-0903
Mailing Address - Country:US
Mailing Address - Phone:864-801-1980
Mailing Address - Fax:864-801-1312
Practice Address - Street 1:3115 BRUSHY CREEK RD STE C-1
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650
Practice Address - Country:US
Practice Address - Phone:864-801-1980
Practice Address - Fax:864-801-1312
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8821Medicare PIN
SCT020778821Medicare UPIN