Provider Demographics
NPI:1790819795
Name:MIDDEKER, WAYNE D (DC)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:D
Last Name:MIDDEKER
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 1:11859 PECOS ST STE 310
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2742
Mailing Address - Country:US
Mailing Address - Phone:303-428-1914
Mailing Address - Fax:303-429-2783
Practice Address - Street 1:11859 PECOS ST STE 310
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2742
Practice Address - Country:US
Practice Address - Phone:303-428-1914
Practice Address - Fax:303-429-2783
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCK1823Medicare PIN