Healthcare Provider Details

I. General information

NPI: 1508138470
Provider Name (Legal Business Name): DEINES CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E ALGER ST
SHERIDAN WY
82801-3911
US

IV. Provider business mailing address

25 E ALGER ST
SHERIDAN WY
82801-3911
US

V. Phone/Fax

Practice location:
  • Phone: 307-673-5075
  • Fax: 370-673-5085
Mailing address:
  • Phone: 307-673-5075
  • Fax: 370-673-5085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number717
License Number StateWY

VIII. Authorized Official

Name: DR. NATE DEINES
Title or Position: OWNER
Credential: D.C.
Phone: 307-673-5075