Provider Demographics
NPI:1770980542
Name:WYANT, ERIN E (DC)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:E
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 1:310 E HIGHWAY 50
Mailing Address - Street 2:STE 2
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2700
Mailing Address - Country:US
Mailing Address - Phone:618-628-4488
Mailing Address - Fax:618-628-4474
Practice Address - Street 1:310 E HIGHWAY 50
Practice Address - Street 2:STE 2
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2700
Practice Address - Country:US
Practice Address - Phone:618-628-4488
Practice Address - Fax:618-628-4474
Is Sole Proprietor?:No
Enumeration Date:2014-11-22
Last Update Date:2014-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor