Provider Demographics
NPI:1285643429
Name:EIBAN, WAYNE ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ROBERT
Last Name:EIBAN
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 1:5301 PROVIDENCE RD
Mailing Address - Street 2:SUITE50
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4128
Mailing Address - Country:US
Mailing Address - Phone:757-495-2228
Mailing Address - Fax:757-495-2216
Practice Address - Street 1:5301 PROVIDENCE RD
Practice Address - Street 2:SUITE50
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4128
Practice Address - Country:US
Practice Address - Phone:757-495-2228
Practice Address - Fax:757-495-2216
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09207Medicare PIN
VAY19524Medicare UPIN