Provider Demographics
NPI:1134623747
Name:WYANT, BROOKE ELIZABETH (DC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELIZABETH
Last Name:WYANT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 42ND ST NE
Mailing Address - Street 2:STE D
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3075
Mailing Address - Country:US
Mailing Address - Phone:319-804-8280
Mailing Address - Fax:319-804-8281
Practice Address - Street 1:1652 42ND ST NE
Practice Address - Street 2:STE D
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3075
Practice Address - Country:US
Practice Address - Phone:319-804-8280
Practice Address - Fax:319-804-8281
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor