MEDICARE: RIVER CHIROPRACTIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1558017434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	505 ANGLERS DR STE 102
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8836
Country	:	US
Telephone Number	:	970-879-6501
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 ANGLERS DR STE 102
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8836
Country	:	US
Telephone Number	:	970-879-6501
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ERIC WILSON
Credential	:	DR OF CHIROPRACTIC
Telephone Number	:	970-879-6501

Provider Enumeration Date	:	03/01/2022
Last Update Date	:	03/01/2022

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