Provider Demographics
NPI:1376685792
Name:WASLYN, NICHOLAS A (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:A
Last Name:WASLYN
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 1:4406 S FLORIDA AVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2182
Mailing Address - Country:US
Mailing Address - Phone:863-701-0109
Mailing Address - Fax:863-701-0309
Practice Address - Street 1:4406 S FLORIDA AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2182
Practice Address - Country:US
Practice Address - Phone:863-701-0109
Practice Address - Fax:863-701-0309
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK603ZMedicare PIN