Provider Demographics
NPI:1235215591
Name:CARTER, WAYNE LESLIE (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:LESLIE
Last Name:CARTER
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 1:2027 COLUMBIA LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3279
Mailing Address - Country:US
Mailing Address - Phone:719-566-1703
Mailing Address - Fax:
Practice Address - Street 1:2027 COLUMBIA LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-3279
Practice Address - Country:US
Practice Address - Phone:719-566-1703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor