Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 08002557A | IN |
NPI | 1003110883 |
---|---|
Provider Name | Mrs. Amanda Kay Wyant |
First Address | Avon, IN 46123-8238 |
Second Address | Avon, IN 46123-8238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2011 |
Last Update Date | 07/01/2011 |