MEDICARE: MR. ZACKERY T WYNN D.C

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	CH12395	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366940116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ZACKERY T WYNN D.C

Provider Business Mailing Address
First Line	:	9782 LITTLE RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-3469
Country	:	US
Telephone Number	:	727-992-9969
Fax Number	:	277-999-5569

Provider Business Practice Location Address
First Line	:	9782 LITTLE RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-3469
Country	:	US
Telephone Number	:	727-992-9969
Fax Number	:	277-999-5569

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

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	02/12/2025

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