Provider Demographics
NPI:1003814773
Name:WYMAN, KEVIN J (D)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:WYMAN
Suffix:
Gender:M
Credentials:D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10076 DARNESTOWN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3363
Mailing Address - Country:US
Mailing Address - Phone:301-208-2225
Mailing Address - Fax:301-294-5103
Practice Address - Street 1:10076 DARNESTOWN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3363
Practice Address - Country:US
Practice Address - Phone:301-208-2225
Practice Address - Fax:301-294-5103
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02159-PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor