Provider Demographics
NPI:1376573451
Name:WHALEN, WAYNE W (DC)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:W
Last Name:WHALEN
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 1:9570 CUYAMACA ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2690
Mailing Address - Country:US
Mailing Address - Phone:619-258-1144
Mailing Address - Fax:619-258-6887
Practice Address - Street 1:9570 CUYAMACA ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2690
Practice Address - Country:US
Practice Address - Phone:619-258-1144
Practice Address - Fax:619-258-6887
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 18999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
W19776Medicare ID - Type Unspecified
CAU35231Medicare UPIN
W14226Medicare ID - Type Unspecified