Provider Demographics
NPI:1689703423
Name:WALBURN, WAYNE IRA (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:IRA
Last Name:WALBURN
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 1:1281 E LA HABRA BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5660
Mailing Address - Country:US
Mailing Address - Phone:562-697-2181
Mailing Address - Fax:562-697-2868
Practice Address - Street 1:1281 E LA HABRA BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-5600
Practice Address - Country:US
Practice Address - Phone:562-697-2181
Practice Address - Fax:562-697-2868
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23608Medicare ID - Type Unspecified
CAU91781Medicare UPIN