Provider Demographics
NPI:1811039647
Name:WRIGHT, WAYNE N (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:N
Last Name:WRIGHT
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 1:4301 13 KALAMAZOO AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3673
Mailing Address - Country:US
Mailing Address - Phone:616-455-7040
Mailing Address - Fax:616-455-0189
Practice Address - Street 1:4301 13 KALAMAZOO AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3673
Practice Address - Country:US
Practice Address - Phone:616-455-7040
Practice Address - Fax:616-455-0189
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOD15060OtherBCBS
MIWW002236OtherPHYSICIAN'S REFERENCE #
MIWW002236OtherPHYSICIAN'S REFERENCE #