Provider Demographics
NPI:1386714293
Name:LADD, WAYNE BROOKS (DC)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:BROOKS
Last Name:LADD
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 1:2136 N COOPER ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-1697
Mailing Address - Country:US
Mailing Address - Phone:765-452-0888
Mailing Address - Fax:765-452-6288
Practice Address - Street 1:2136 N COOPER ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-1697
Practice Address - Country:US
Practice Address - Phone:765-452-0888
Practice Address - Fax:765-452-6288
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001690A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200412100AMedicaid
INU63251Medicare UPIN
IN210570AMedicare PIN