Organization
WYATT CHIROPRACTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK WYATT DC (OWNER/CHIROPRACTOR)
(931) 802-6711
Entity
Organization
Contact information
Practice address
170 HOLIDAY DR, CLARKSVILLE, TN 37040-5023
(931) 802-6711
(931) 802-6712
Mailing address
170 HOLIDAY DR, CLARKSVILLE, TN 37040-5023
(931) 802-6711
(931) 802-6712
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2098
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000630607
ANTHEM PIN
TN
Enumeration date
05/11/2017
Last updated
05/11/2017
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