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General NPI Number Information
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NPI Number | 1881466563
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Entity Type | Organization
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Legal Business Name | SPINE CHIROPRACTIC CENTER PLLC
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 111A W GUM ST
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City | MARION
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State | KY
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Zip | 42064-1533
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Country | US
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Telephone | 270-965-7002
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Fax |
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Provider Business Mailing Address
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Address Line | 111A W GUM ST
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City | MARION
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State | KY
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Zip | 42064-1533
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Country | US
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Telephone | 270-965-7002
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. CHRISTOPHER SCOTT WYNN
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Credential | DC
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Telephone | 270-965-7002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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