Healthcare Provider Details

I. General information

NPI: 1396801908
Provider Name (Legal Business Name): HEALING ELEMENT CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 N 10TH ST E
RIVERTON WY
82501-2906
US

IV. Provider business mailing address

PO BOX 1457
RIVERTON WY
82501-0160
US

V. Phone/Fax

Practice location:
  • Phone: 307-856-6612
  • Fax: 307-856-1767
Mailing address:
  • Phone: 307-856-6612
  • Fax: 307-856-1767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number645
License Number StateWY

VIII. Authorized Official

Name: JONATHAN L. FAUBION
Title or Position: OFFICER
Credential: D.C.
Phone: 307-856-6612