Provider Demographics
NPI:1578573598
Name:WAYNE CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:WAYNE CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:919-778-7871
Mailing Address - Street 1:1401 N BERKELEY BLVD
Mailing Address - Street 2:STE H
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534
Mailing Address - Country:US
Mailing Address - Phone:919-778-7871
Mailing Address - Fax:919-778-0081
Practice Address - Street 1:1401 N BERKELEY BLVD
Practice Address - Street 2:STE H
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534
Practice Address - Country:US
Practice Address - Phone:919-778-7871
Practice Address - Fax:919-778-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890834RMedicaid
NC0834ROtherBCBS
NC0834ROtherBCBS
NC2453413CMedicare ID - Type Unspecified