MEDICARE: DANIEL L WYMER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104000614	VA
2	111N00000X	Chiropractor	CH1981	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55321	OTHER	FL	PTAN

General Provider Information

NPI Number	:	1235132218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL L WYMER DC

Provider Business Mailing Address
First Line	:	11023 GATEWOOD DR STE 101
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34211-4945
Country	:	US
Telephone Number	:	941-744-1585
Fax Number	:	941-744-1572

Provider Business Practice Location Address
First Line	:	11023 GATEWOOD DR STE 101
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34211-4945
Country	:	US
Telephone Number	:	941-744-1585
Fax Number	:	941-744-1572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/10/2019

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Directions to “ DANIEL L WYMER DC” Practice Location

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