Provider Demographics
NPI:1609928506
Name:HOOVER, WAYNE (DC)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:HOOVER
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 1:1228 E MAIN ST # 2
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5821
Mailing Address - Country:US
Mailing Address - Phone:970-249-2233
Mailing Address - Fax:297-024-9092
Practice Address - Street 1:1228 E MAIN ST # 2
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5821
Practice Address - Country:US
Practice Address - Phone:970-249-2233
Practice Address - Fax:297-024-9092
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor