Provider Demographics
NPI:1952369035
Name:WAYSON, BLAKE J (DC)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:J
Last Name:WAYSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4619 CHADWICK RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-8060
Mailing Address - Country:US
Mailing Address - Phone:319-266-1119
Mailing Address - Fax:319-266-5275
Practice Address - Street 1:4619 CHADWICK RD
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-8060
Practice Address - Country:US
Practice Address - Phone:319-266-1119
Practice Address - Fax:319-266-5275
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07291OtherWELLMARK BCBS OF IOWA
IA0480830Medicaid
I17326Medicare PIN
IA07291OtherWELLMARK BCBS OF IOWA