Provider Demographics
NPI:1366459232
Name:MOYER, WAYNE STANLEY (DC QME,IDE)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:STANLEY
Last Name:MOYER
Suffix:
Gender:M
Credentials:DC QME,IDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4631
Mailing Address - Country:US
Mailing Address - Phone:619-442-3444
Mailing Address - Fax:619-442-3764
Practice Address - Street 1:757 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4631
Practice Address - Country:US
Practice Address - Phone:619-442-3444
Practice Address - Fax:619-442-3764
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2009-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor