Provider Demographics
NPI:1962454751
Name:WOLFSON, WAYNE C (DC)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:C
Last Name:WOLFSON
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 1:205 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1203
Mailing Address - Country:US
Mailing Address - Phone:407-649-9699
Mailing Address - Fax:407-649-8991
Practice Address - Street 1:205 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1203
Practice Address - Country:US
Practice Address - Phone:407-649-9699
Practice Address - Fax:407-649-8991
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T55736Medicare UPIN
FL88195ZMedicare ID - Type Unspecified