Provider Demographics
NPI:1851362206
Name:CARNEY, WAYNE VICTOR (DC)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:VICTOR
Last Name:CARNEY
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 1:514 E GEORGE WASHINGTON BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803
Mailing Address - Country:US
Mailing Address - Phone:563-322-3023
Mailing Address - Fax:563-322-3023
Practice Address - Street 1:514 E GEORGE WASHINGTON BLVD
Practice Address - Street 2:STE 2
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803
Practice Address - Country:US
Practice Address - Phone:563-322-3023
Practice Address - Fax:563-322-3023
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA49999OtherBLUE CROSS
IA0261669Medicaid
IA49999OtherBLUE CROSS