Provider Demographics
NPI:1336293489
Name:SODANO, WAYNE L (DC, DABCI)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:L
Last Name:SODANO
Suffix:
Gender:M
Credentials:DC, DABCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29791 BAYSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-3917
Mailing Address - Country:US
Mailing Address - Phone:410-458-3133
Mailing Address - Fax:443-327-4763
Practice Address - Street 1:29791 BAYSTONE WAY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-3917
Practice Address - Country:US
Practice Address - Phone:410-458-3133
Practice Address - Fax:443-327-4763
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEFI-0011052111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522358293OtherFEIN
MDT59496Medicare UPIN