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General NPI Number Information
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NPI Number | 1164604872
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Entity Type | Organization
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Legal Business Name | ESSENTIAL CHIROPRACTIC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 151 W MINERAL AVE #105
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City | LITTLETON
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State | CO
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Zip | 80120-5611
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Country | US
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Telephone | 303-730-7445
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Fax |
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Provider Business Mailing Address
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Address Line | 151 W MINERAL AVE #105
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City | LITTLETON
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State | CO
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Zip | 80120-5611
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Country | US
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Telephone | 303-730-7445
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | H M WISE
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Credential | D.C
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Telephone | 303-730-7445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 3900
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License Number State | CO
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