1134127103 NPI number — WAYNE M WHALEN, DC, A CHIROPRACTIC

Table of content: (NPI 1134127103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134127103 NPI number — WAYNE M WHALEN, DC, A CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAYNE M WHALEN, DC, A CHIROPRACTIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WHALEN CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134127103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9570 CUYAMACA ST
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
SANTEE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92071-2690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-258-1144
Provider Business Mailing Address Fax Number:
619-258-6887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9570 CUYAMACA ST
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-2690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-258-1144
Provider Business Practice Location Address Fax Number:
619-258-6887
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WHALEN
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
MARTIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
619-258-1144

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC18999 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NN0400X , with the licence number: 18999 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC18999 . This is a "BD OF CHIROPRACTIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1134127103 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: W19776 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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