Provider Demographics
NPI:1538860143
Name:GWYNNE, JOHN CARTER (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARTER
Last Name:GWYNNE
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 1:14515 BRIAR FOREST DR APT 1214
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2096
Mailing Address - Country:US
Mailing Address - Phone:540-908-7378
Mailing Address - Fax:
Practice Address - Street 1:22167 WESTHEIMER PKWY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-8300
Practice Address - Country:US
Practice Address - Phone:281-347-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15422111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician