Provider Demographics
NPI:1639361330
Name:POTTER, WAYNE A (DC)
Entity Type:Individual
Prefix:PROF
First Name:WAYNE
Middle Name:A
Last Name:POTTER
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 1:6711 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:TN
Mailing Address - Zip Code:37037-5311
Mailing Address - Country:US
Mailing Address - Phone:931-684-2926
Mailing Address - Fax:931-773-3033
Practice Address - Street 1:210 S MAIN ST # 1E
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3906
Practice Address - Country:US
Practice Address - Phone:931-684-2926
Practice Address - Fax:931-773-3033
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0058690OtherBCBS
TN3673753Medicare PIN