Healthcare Provider Details

I. General information

NPI: 1184692014
Provider Name (Legal Business Name): MARK ANDREW WYATT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106A TRENTON RD WYATT FAMILY CHIROPRACTIC
CLARKSVILLE TN
37040-1609
US

IV. Provider business mailing address

2106A TRENTON RD DR MARK A WYATT
CLARKSVILLE TN
37040-1609
US

V. Phone/Fax

Practice location:
  • Phone: 931-647-7677
  • Fax: 931-647-0122
Mailing address:
  • Phone: 931-647-7677
  • Fax: 931-647-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2098
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC0000002098
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: