Provider Demographics
NPI:1154417558
Name:COLEMAN, WAYNE D (DC)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:D
Last Name:COLEMAN
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 1:5510 SUNOL BLVD.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-8856
Mailing Address - Country:US
Mailing Address - Phone:925-846-2878
Mailing Address - Fax:925-846-2879
Practice Address - Street 1:5510 SUNOL BLVD.
Practice Address - Street 2:SUITE 5
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-8856
Practice Address - Country:US
Practice Address - Phone:925-846-2878
Practice Address - Fax:925-846-2879
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC018765OtherBLUE SHIELD PROVIDER
CADC0187651Medicare PIN