Healthcare Provider Details

I. General information

NPI: 1487019139
Provider Name (Legal Business Name): EPIC CHIROPRACTIC OF CASPER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 ENERGY LN SUITE 301
CASPER WY
82604-2941
US

IV. Provider business mailing address

3211 ENERGY LN SUITE 301
CASPER WY
82604-2941
US

V. Phone/Fax

Practice location:
  • Phone: 307-224-2244
  • Fax: 855-777-3613
Mailing address:
  • Phone: 307-224-2244
  • Fax: 855-777-3613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number742
License Number StateWY

VIII. Authorized Official

Name: DR. MICHELE GENE MUNOZ
Title or Position: OWNER
Credential: DC
Phone: 817-408-5685