Provider Demographics
NPI:1114938230
Name:WOMACK, MICHAEL WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:WOMACK
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 1:1501 AVOCADO AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-6593
Mailing Address - Country:US
Mailing Address - Phone:321-339-8876
Mailing Address - Fax:321-541-9114
Practice Address - Street 1:1501 AVOCADO AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6593
Practice Address - Country:US
Practice Address - Phone:321-339-8876
Practice Address - Fax:321-541-9114
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380075000Medicaid
FL70956Medicare ID - Type Unspecified
FL380075000Medicaid
FL70956ZMedicare PIN