Provider Demographics
NPI:1225105554
Name:C S WYNN D C CHIROPRACTIC OFFICES INC
Entity Type:Organization
Organization Name:C S WYNN D C CHIROPRACTIC OFFICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-582-2684
Mailing Address - Street 1:1080 N IRWIN ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-2949
Mailing Address - Country:US
Mailing Address - Phone:559-582-2684
Mailing Address - Fax:559-582-9275
Practice Address - Street 1:1080 N IRWIN ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-2949
Practice Address - Country:US
Practice Address - Phone:559-582-2684
Practice Address - Fax:559-582-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC09970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGDC000290Medicaid
CAT03776Medicare UPIN
CAZZZ20172ZMedicare ID - Type Unspecified