Provider Demographics
NPI:1891853768
Name:DEPAZ, WAYNE CAREY (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:CAREY
Last Name:DEPAZ
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 1:1017 E HWY 80
Mailing Address - Street 2:SUITE 17
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322
Mailing Address - Country:US
Mailing Address - Phone:912-748-9125
Mailing Address - Fax:912-826-0352
Practice Address - Street 1:1017 E HWY 80
Practice Address - Street 2:SUITE 17
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322
Practice Address - Country:US
Practice Address - Phone:912-748-9125
Practice Address - Fax:912-826-0352
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBSGMedicare ID - Type Unspecified
U18348Medicare UPIN