Provider Demographics
NPI:1629138672
Name:CONLON, WAYNE PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:PETER
Last Name:CONLON
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 1:5759 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997
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
Practice Address - Country:US
Practice Address - Phone:772-220-9565
Practice Address - Fax:772-220-0964
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53994AOtherBLUE CROSS
FLK4326Medicare ID - Type Unspecified