Provider Demographics
NPI:1134127103
Name:WAYNE M WHALEN, DC, A CHIROPRACTIC
Entity Type:Organization
Organization Name:WAYNE M WHALEN, DC, A CHIROPRACTIC
Other - Org Name:WHALEN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-258-1144
Mailing Address - Street 1:9570 CUYAMACA ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2690
Mailing Address - Country:US
Mailing Address - Phone:619-258-1144
Mailing Address - Fax:619-258-6887
Practice Address - Street 1:9570 CUYAMACA ST
Practice Address - Street 2:STE 101
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2690
Practice Address - Country:US
Practice Address - Phone:619-258-1144
Practice Address - Fax:619-258-6887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18999111N00000X
CA18999111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18999OtherBD OF CHIROPRACTIC
1134127103OtherNPI
W19776OtherMEDICARE PTAN
W19776OtherMEDICARE PTAN