Provider Demographics
NPI:1982775052
Name:WYATT, JOHN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:WYATT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 RESEARCH FOREST DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SPRING
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:SPRING
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor