Healthcare Provider Details

I. General information

NPI: 1043352347
Provider Name (Legal Business Name): THORNALLY REHAB AND WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6189 LEHMAN DR SUITE 105
COLORADO SPRINGS CO
80918-5407
US

IV. Provider business mailing address

6189 LEHMAN DR SUITE 105
COLORADO SPRINGS CO
80918-5407
US

V. Phone/Fax

Practice location:
  • Phone: 719-594-4400
  • Fax: 719-594-2038
Mailing address:
  • Phone: 719-594-4400
  • Fax: 719-594-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2770
License Number StateCO

VIII. Authorized Official

Name: CRAIG T THORNALLY
Title or Position: OWNER OPPERATOR
Credential: DC
Phone: 719-594-4400