Healthcare Provider Details

I. General information

NPI: 1134623747
Provider Name (Legal Business Name): BROOKE ELIZABETH WYANT DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 42ND ST NE STE D
CEDAR RAPIDS IA
52402-3075
US

IV. Provider business mailing address

1652 42ND ST NE STE D
CEDAR RAPIDS IA
52402-3075
US

V. Phone/Fax

Practice location:
  • Phone: 319-804-8280
  • Fax: 319-804-8281
Mailing address:
  • Phone: 319-804-8280
  • Fax: 319-804-8281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number090662
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-318929
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: