Healthcare Provider Details

I. General information

NPI: 1275685984
Provider Name (Legal Business Name): PETER JAMES WYLAND DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 WATER AVE.
HILLSBORO WI
54634
US

IV. Provider business mailing address

652 WATER AVE P.O.BOX 414
HILLSBORO WI
54634-0414
US

V. Phone/Fax

Practice location:
  • Phone: 608-489-3232
  • Fax: 608-489-3329
Mailing address:
  • Phone: 608-489-3232
  • Fax: 608-489-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1409-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: