NPIMap

Individual provider Active NPI

Kevin J. Wyman, D.

  • Chiropractor
  • Rockville, MD
National Provider Identifier
1003814773
Registry record updated May 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
02159-PT Issued in MD
Practice address
10076 Darnestown Rd
Suite 200
Rockville, MD 20850-3363
Phone
(301) 208-2225
Fax
(301) 294-5103
NPI assigned
Jul 7, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 13, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 02159-PT MD Primary

Addresses

Primary practice location

10076 Darnestown Rd
Suite 200
Rockville, MD 20850-3363

Mailing address

10076 Darnestown Rd
Suite 200
Rockville, MD 20850-3363
Phone (301) 208-2225

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
02159-PTMDMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Chiropractic and Rehabilitation Clinic, LLP Chiropractor Past Accepting new patients
Progressive Spinal and Sports Rehabilitation, PC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242172800000",
    "number": "1003814773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10076 DARNESTOWN RD",
            "address_2": "SUITE 200",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503363",
            "telephone_number": "301-208-2225",
            "fax_number": "301-294-5103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10076 DARNESTOWN RD",
            "address_2": "SUITE 200",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503363",
            "telephone_number": "301-208-2225",
            "fax_number": "301-294-5103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYMAN",
        "first_name": "KEVIN",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2009-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "02159-PT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.