Provider Demographics
NPI:1942422753
Name:BULLEN, WAYNE PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:PETER
Last Name:BULLEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11215 OAK LEAF DR
Mailing Address - Street 2:1118
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1317
Mailing Address - Country:US
Mailing Address - Phone:202-210-9093
Mailing Address - Fax:202-966-9380
Practice Address - Street 1:5530 WISCONSIN AVE STE 1248
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4301
Practice Address - Country:US
Practice Address - Phone:202-966-9280
Practice Address - Fax:202-966-9380
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor