Provider Demographics
NPI:1356403059
Name:DENTROUX, WAYNE MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:MICHAEL
Last Name:DENTROUX
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 1:173 COMMODORE RD
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-4826
Mailing Address - Country:US
Mailing Address - Phone:609-660-2058
Mailing Address - Fax:
Practice Address - Street 1:901 ROUTE 168
Practice Address - Street 2:SUITE 405
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3210
Practice Address - Country:US
Practice Address - Phone:856-374-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor