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General NPI Number Information
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NPI Number | 1134425325
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Entity Type | Organization
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Legal Business Name | 100 A CHIROPRACTIC WELLNESS CENTER NORTH LLC
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Dates
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Enumeration Date | 02/04/2011
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Last Update Date | 06/05/2020
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Provider Practice Location Address
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Address Line | 1720 JET STREAM DR SUITE 115
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-3938
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Country | US
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Telephone | 719-867-3007
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Fax | 719-867-3000
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Provider Business Mailing Address
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Address Line | 1720 JET STREAM DR SUITE 115
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-3938
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Country | US
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Telephone | 719-867-3007
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Fax | 719-867-3000
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRANDON LIVINGOOD
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Credential | D.C.
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Telephone | 718-867-3007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6324
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License Number State | CO
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