Individual
DR. MARANDA NICOLE WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
2202 EASTLAND DR, SUITE B, BLOOMINGTON, IL 61704-3585
(309) 303-0716
Mailing address
1821 COUNTY ROAD 2100 N, WASHBURN, IL 61570-9324
(309) 303-0716
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038.011334
IL
Other
Enumeration date
02/05/2009
Last updated
02/05/2009
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