Provider Demographics
NPI:1518149558
Name:WAYNE P. CONLON & LAURIE J. CONLON, PTNRS
Entity Type:Organization
Organization Name:WAYNE P. CONLON & LAURIE J. CONLON, PTNRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CONLON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-220-9565
Mailing Address - Street 1:5759 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8545
Mailing Address - Country:US
Mailing Address - Phone:772-220-9565
Mailing Address - Fax:772-220-0964
Practice Address - Street 1:5759 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8545
Practice Address - Country:US
Practice Address - Phone:772-220-9565
Practice Address - Fax:772-220-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-01
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4326OtherMEDICARE GROUP ID
FL53994AMedicare PIN
FLU94763Medicare UPIN