Provider Demographics
NPI:1396714630
Name:CARR, WAYNE H (DC)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:H
Last Name:CARR
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 1:2065 CAMPBELL DR
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-3433
Mailing Address - Country:US
Mailing Address - Phone:605-352-5264
Mailing Address - Fax:605-352-9776
Practice Address - Street 1:2065 CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-3433
Practice Address - Country:US
Practice Address - Phone:605-352-5264
Practice Address - Fax:605-352-9776
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0080146OtherBSSD
SD460408441OtherMEDICA
SD4999856OtherBSSD
SD512487OtherAMPPO
SD7603433Medicaid
SD0086554OtherBSSD
SD27937OtherSVHP
SD7603430Medicaid
SD7603432Medicaid
S86554Medicare PIN
SD0086554OtherBSSD
SD7603432Medicaid
SD350034692Medicare PIN
SD350034685Medicare PIN