Provider Demographics
NPI:1306190947
Name:WAYNE S. CARR D.C. DBA CARR CHIROPRACTIC
Entity Type:Organization
Organization Name:WAYNE S. CARR D.C. DBA CARR CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-431-7255
Mailing Address - Street 1:711 HEALDSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3671
Mailing Address - Country:US
Mailing Address - Phone:707-431-7255
Mailing Address - Fax:707-431-7256
Practice Address - Street 1:711 HEALDSBURG AVE
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3671
Practice Address - Country:US
Practice Address - Phone:707-431-7255
Practice Address - Fax:707-431-7256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty