Healthcare Provider Details

I. General information

NPI: 1770799744
Provider Name (Legal Business Name): PUEBLO WEST CHIROPRACTIC CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 S PURCELL BLVD
PUEBLO WEST CO
81007-5081
US

IV. Provider business mailing address

171 S PURCELL BLVD
PUEBLO WEST CO
81007-5081
US

V. Phone/Fax

Practice location:
  • Phone: 719-547-1979
  • Fax: 719-547-7336
Mailing address:
  • Phone: 719-547-1979
  • Fax: 719-547-7336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCO4091
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCO4489
License Number StateCO

VIII. Authorized Official

Name: DR. ANGELA ELAINE VIK
Title or Position: CO-OWNER
Credential: D.C.
Phone: 719-547-1979