Provider Demographics
NPI:1851326102
Name:BROOKS, WAYLAND ALVA (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYLAND
Middle Name:ALVA
Last Name:BROOKS
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 1:109 WAVERLY PLZ
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-1531
Mailing Address - Country:US
Mailing Address - Phone:931-296-9176
Mailing Address - Fax:931-296-1341
Practice Address - Street 1:109 WAVERLY PLZ
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1531
Practice Address - Country:US
Practice Address - Phone:931-296-9176
Practice Address - Fax:931-296-1341
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC00000000291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT74513Medicare UPIN
TN3672425Medicare ID - Type Unspecified