Provider Demographics
NPI:1730179557
Name:RICE, WAYNE WALKER (DC)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:WALKER
Last Name:RICE
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 1:1500 E VENICE AVE UNIT 405
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1666
Mailing Address - Country:US
Mailing Address - Phone:941-484-0940
Mailing Address - Fax:941-485-4831
Practice Address - Street 1:1500 E VENICE AVE UNIT 405
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1666
Practice Address - Country:US
Practice Address - Phone:941-484-0940
Practice Address - Fax:941-485-4831
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381035600Medicaid
U68692Medicare UPIN
FL381035600Medicaid