Provider Demographics
NPI:1649331687
Name:WAYNE BUESSING DC PC
Entity type:Organization
Organization Name:WAYNE BUESSING DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BUESSING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-599-4343
Mailing Address - Street 1:1970 DOMINION WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1465
Mailing Address - Country:US
Mailing Address - Phone:719-599-4343
Mailing Address - Fax:719-599-8044
Practice Address - Street 1:1970 DOMINION WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1465
Practice Address - Country:US
Practice Address - Phone:719-599-4343
Practice Address - Fax:719-599-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC801284Medicare ID - Type UnspecifiedDOMINION CHIROPRACTIC