Provider Demographics
NPI:1316014343
Name:NETLEY, WAYNE P (DC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:P
Last Name:NETLEY
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 1:1106 WEST PARK ST
Mailing Address - Street 2:STE 2
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047
Mailing Address - Country:US
Mailing Address - Phone:406-222-2999
Mailing Address - Fax:406-222-2361
Practice Address - Street 1:1106 WEST PARK ST
Practice Address - Street 2:STE 2
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047
Practice Address - Country:US
Practice Address - Phone:406-222-2999
Practice Address - Fax:406-222-2361
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4386Medicare ID - Type Unspecified