Healthcare Provider Details

I. General information

NPI: 1316437577
Provider Name (Legal Business Name): PLATTE VALLEY CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W ROCHESTER AVE
SARATOGA WY
82331
US

IV. Provider business mailing address

3 WILDWOOD RD
MCFADDEN WY
82083-9000
US

V. Phone/Fax

Practice location:
  • Phone: 307-326-3324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number680
License Number StateWY

VIII. Authorized Official

Name: KENDRA SIMS
Title or Position: OWNER
Credential:
Phone: 307-326-3324