Provider Demographics
NPI:1952625667
Name:CISSELL, WAYNE ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ANTHONY
Last Name:CISSELL
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 1:1830 E PARKS HWY
Mailing Address - Street 2:SUITE A120
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7378
Mailing Address - Country:US
Mailing Address - Phone:907-373-5054
Mailing Address - Fax:907-373-5058
Practice Address - Street 1:1830 E PARKS HWY
Practice Address - Street 2:SUITE A120
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7378
Practice Address - Country:US
Practice Address - Phone:907-373-5054
Practice Address - Fax:907-373-5058
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31505111N00000X
AK544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor