Provider Demographics
NPI:1194272450
Name:WAFO, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:WAFO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7012 PRESLEY RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3466
Mailing Address - Country:US
Mailing Address - Phone:508-627-2342
Mailing Address - Fax:
Practice Address - Street 1:7012 PRESLEY RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3466
Practice Address - Country:US
Practice Address - Phone:508-627-2342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-04
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557883111N00000X, 111NI0013X
MD04183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111N00000XChiropractic ProvidersChiropractor