Provider Demographics
NPI:1962654285
Name:PETERMANN, WAYNE ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ANDREW
Last Name:PETERMANN
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 1:20 BURNETT BROOK DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-2101
Mailing Address - Country:US
Mailing Address - Phone:973-543-5881
Mailing Address - Fax:
Practice Address - Street 1:15 1/2 HOWE AVE.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4001
Practice Address - Country:US
Practice Address - Phone:973-614-0048
Practice Address - Fax:973-614-0030
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00341900111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician