Healthcare Provider Details

I. General information

NPI: 1366913261
Provider Name (Legal Business Name): WOW FAMILY CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 CAMPUS DR STE 230
COLORADO SPRINGS CO
80920-3177
US

IV. Provider business mailing address

7150 CAMPUS DR STE 230
COLORADO SPRINGS CO
80920-3177
US

V. Phone/Fax

Practice location:
  • Phone: 719-627-4969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN DAVIS
Title or Position: PRESIDENT
Credential: DC
Phone: 719-627-4969