Provider Demographics
NPI:1639345531
Name:DR NICK WASLYN DC P A
Entity Type:Organization
Organization Name:DR NICK WASLYN DC P A
Other - Org Name:AMERICAN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:WASLYN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-701-0109
Mailing Address - Street 1:4406 S FLORIDA AVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2172
Mailing Address - Country:US
Mailing Address - Phone:863-701-0109
Mailing Address - Fax:863-701-0309
Practice Address - Street 1:4406 S FLORIDA AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2172
Practice Address - Country:US
Practice Address - Phone:863-701-0109
Practice Address - Fax:863-701-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK604Medicare PIN