Provider Demographics
NPI:1467536748
Name:FENTON, WAYNE JOHN (DC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:JOHN
Last Name:FENTON
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:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-0429
Mailing Address - Country:US
Mailing Address - Phone:828-635-7400
Mailing Address - Fax:828-635-7415
Practice Address - Street 1:99 7TH STREET SW
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625
Practice Address - Country:US
Practice Address - Phone:828-635-7400
Practice Address - Fax:828-635-7415
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890822GMedicaid
NC0822GOtherBCBS
NC890822GMedicaid