Provider Demographics
NPI:1558356634
Name:FICHTER, WAYNE MARVIN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:MARVIN
Last Name:FICHTER
Suffix:JR
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 1:2721 EAST SPRAGUE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202
Mailing Address - Country:US
Mailing Address - Phone:509-535-3038
Mailing Address - Fax:509-535-9749
Practice Address - Street 1:2721 EAST SPRAGUE AVENUE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-535-3038
Practice Address - Fax:509-535-9749
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008847111N00000X
WACH60210207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA067762V3DMedicare PIN
PAU94201Medicare UPIN