Provider Demographics
NPI:1235132218
Name:WYMER, DANIEL L (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:WYMER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11023 GATEWOOD DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4945
Mailing Address - Country:US
Mailing Address - Phone:941-744-1585
Mailing Address - Fax:941-744-1572
Practice Address - Street 1:11023 GATEWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-4945
Practice Address - Country:US
Practice Address - Phone:941-744-1585
Practice Address - Fax:941-744-1572
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000614111N00000X
FLCH1981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55321OtherPTAN
FL55321OtherPTAN
VA350001130Medicare PIN