Provider Demographics
NPI:1205986148
Name:HUNSAKER, WAYNE L (DC)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:L
Last Name:HUNSAKER
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 1:150 E 200 N
Mailing Address - Street 2:SUITE I
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4036
Mailing Address - Country:US
Mailing Address - Phone:435-752-2962
Mailing Address - Fax:
Practice Address - Street 1:150 E 200 N
Practice Address - Street 2:SUITE I
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4036
Practice Address - Country:US
Practice Address - Phone:435-752-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT154200-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000005597Medicare ID - Type Unspecified
T78022Medicare UPIN