Healthcare Provider Details

I. General information

NPI: 1225398043
Provider Name (Legal Business Name): WHOLE FOOD NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2012
Last Update Date: 05/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9075 FORSSTROM DR
LONETREE CO
80124-6737
US

IV. Provider business mailing address

9075 FORSSTROM DR
LONETREE CO
80124-6737
US

V. Phone/Fax

Practice location:
  • Phone: 303-470-1995
  • Fax:
Mailing address:
  • Phone: 303-470-1995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR-6791
License Number StateCO

VIII. Authorized Official

Name: LINDSAY WILSON
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 303-470-1995