Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 4252 | NC |
NPI | 1184783367 |
---|---|
Provider Name | Dr. Arnie Wynn |
First Address | Charlotte, NC 28209-2806 |
Second Address | Charlotte, NC 28202-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 01/04/2013 |