Provider Demographics
NPI:1689760928
Name:SIMERLEIN, WAYNE ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ALLEN
Last Name:SIMERLEIN
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 1:371E US 20
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-9510
Mailing Address - Country:US
Mailing Address - Phone:219-872-7176
Mailing Address - Fax:219-872-7176
Practice Address - Street 1:371E US 20
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-9510
Practice Address - Country:US
Practice Address - Phone:219-872-7176
Practice Address - Fax:219-872-7176
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000438A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000078999OtherANTHEM IN
651900Medicare ID - Type Unspecified