Healthcare Provider Details

I. General information

NPI: 1467111930
Provider Name (Legal Business Name): WYANT FAMILY CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
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 Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BROOKE WYANT
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 319-721-8738