Provider Demographics
NPI:1568446284
Name:PRICKETT, WAYNE J (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:J
Last Name:PRICKETT
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 1:3814 BROWNING PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7166
Mailing Address - Country:US
Mailing Address - Phone:919-782-4733
Mailing Address - Fax:919-783-8225
Practice Address - Street 1:3814 BROWNING PL
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7166
Practice Address - Country:US
Practice Address - Phone:919-782-4733
Practice Address - Fax:919-783-8225
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor