Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 02159-PT | MD |
NPI | 1003814773 |
---|---|
Provider Name | Dr. Kevin J. Wyman |
First Address | Rockville, MD 20850-3363 |
Second Address | Rockville, MD 20850-3363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 13/05/2009 |