Healthcare Provider Details

I. General information

NPI: 1437971348
Provider Name (Legal Business Name): LOUISVILLE CHIROPRACTIC & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 12/03/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 WEST SOUTH BOULDER ROAD SUITE 4
LOUISVILLE CO
80027
US

IV. Provider business mailing address

333 WEST SOUTH BOULDER ROAD SUITE 4
LOUISVILLE CO
80027
US

V. Phone/Fax

Practice location:
  • Phone: 720-457-9509
  • Fax: 720-861-0979
Mailing address:
  • Phone: 720-457-9509
  • Fax: 720-861-0979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ERIC R WILSON
Title or Position: OWNER
Credential: D.C.
Phone: 805-704-5376