Healthcare Provider Details

I. General information

NPI: 1386962553
Provider Name (Legal Business Name): WILEY CHIROPRACTIC GROUP P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MAIN ST SUITE 6
ALAMOSA CO
81101-2672
US

IV. Provider business mailing address

511 MAIN ST SUITE 6
ALAMOSA CO
81101-2672
US

V. Phone/Fax

Practice location:
  • Phone: 719-589-5163
  • Fax: 719-589-8988
Mailing address:
  • Phone: 719-589-5163
  • Fax: 719-589-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1181
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1181
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number1181
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number1181
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1181
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1181
License Number StateCO

VIII. Authorized Official

Name: DR. TERRY L WILEY
Title or Position: PRESIDENT
Credential: DC
Phone: 719-589-5163