Provider Demographics
NPI:1659596930
Name:WYATT SPINE CENTER
Entity Type:Organization
Organization Name:WYATT SPINE CENTER
Other - Org Name:SPINAL AID
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-465-9777
Mailing Address - Street 1:1500 RESEARCH FOREST DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4373
Mailing Address - Country:US
Mailing Address - Phone:281-465-9777
Mailing Address - Fax:281-465-9780
Practice Address - Street 1:1500 RESEARCH FOREST DR
Practice Address - Street 2:SUITE 120
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-4373
Practice Address - Country:US
Practice Address - Phone:281-465-9777
Practice Address - Fax:281-465-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty