=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184783367
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARNIE WYNN D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 E 7TH ST SUITE 2A
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28202-2923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-299-1700
-----------------------------------------------------
Fax | 704-299-1700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1128 KURT CT
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28209-2806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-299-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | 4252
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------