Provider Demographics
NPI:1881870012
Name:WAYSON FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:WAYSON FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-266-1119
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07291OtherBCBS
IA0480830Medicaid
IAI17326Medicare PIN
IA07291OtherBCBS