Provider Demographics
NPI:1023177649
Name:ENLOE, WAYNE THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:THOMAS
Last Name:ENLOE
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 1:1600 N HIGH POINT RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3635
Mailing Address - Country:US
Mailing Address - Phone:608-831-0453
Mailing Address - Fax:608-836-4884
Practice Address - Street 1:1424 N HIGH POINT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3682
Practice Address - Country:US
Practice Address - Phone:608-831-0453
Practice Address - Fax:608-836-4884
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3418-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38901500Medicaid
WI000135210Medicare ID - Type Unspecified
WIU66152Medicare UPIN