Provider Demographics
NPI:1326752494
Name:WYSE, LEVI J (DC)
Entity Type:Individual
Prefix:DR
First Name:LEVI
Middle Name:J
Last Name:WYSE
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 1:301B STRYKER ST
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502-1144
Mailing Address - Country:US
Mailing Address - Phone:567-444-4574
Mailing Address - Fax:
Practice Address - Street 1:301B STRYKER ST
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-1144
Practice Address - Country:US
Practice Address - Phone:567-444-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor