Provider Demographics
NPI:1275699183
Name:LUTZ, WAYNE HEISTER (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:HEISTER
Last Name:LUTZ
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:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-0478
Mailing Address - Country:US
Mailing Address - Phone:609-703-2314
Mailing Address - Fax:
Practice Address - Street 1:208 ASBURY AVE
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-4122
Practice Address - Country:US
Practice Address - Phone:609-703-2314
Practice Address - Fax:570-759-9635
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00224600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLU143948Medicare ID - Type Unspecified