Provider Demographics
NPI:1518047703
Name:HORN, WAYNE SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:SCOTT
Last Name:HORN
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 2052
Mailing Address - Street 2:
Mailing Address - City:ROANAKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3165
Mailing Address - Country:US
Mailing Address - Phone:252-537-2425
Mailing Address - Fax:252-537-4809
Practice Address - Street 1:400 BECKER DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:ROANAKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3165
Practice Address - Country:US
Practice Address - Phone:252-537-2425
Practice Address - Fax:252-537-4809
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0850NOtherBCBS NC
NC890850NMedicaid
2449773AMedicare ID - Type Unspecified
U58765Medicare UPIN