Provider Demographics
NPI:1720032188
Name:KIRK, WAYNE FRANKLIN (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:FRANKLIN
Last Name:KIRK
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 1:2333 WASHINGTON AVE.
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-2349
Mailing Address - Country:US
Mailing Address - Phone:812-477-5201
Mailing Address - Fax:812-477-5293
Practice Address - Street 1:2333 WASHINGTON AVE.
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-2349
Practice Address - Country:US
Practice Address - Phone:812-477-5201
Practice Address - Fax:812-477-5293
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001920A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200279220AMedicaid
IN350053694OtherRAILROAD MEDICARE
IN000000112035OtherANTHEM
IN000000112035OtherANTHEM
IN152640Medicare ID - Type Unspecified