=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316662653
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GWENYTH SKYLAR MAJERCIN DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2022
-----------------------------------------------------
Last Update Date | 10/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5640 MARQUESAS CIR
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233-3331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-921-5741
-----------------------------------------------------
Fax | 941-927-5746
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5640 MARQUESAS CIR
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233-3331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-921-5741
-----------------------------------------------------
Fax | 941-927-5746
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH14241
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------