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General NPI Number Information
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NPI Number | 1184129694
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Entity Type | Organization
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Legal Business Name | CORE STRENGTH CHIROPRACTIC LLC
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 498 HARLOW RD STE 3
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City | SPRINGFIELD
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State | OR
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Zip | 97477-1339
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Country | US
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Telephone | 541-341-1414
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Fax | 541-653-8570
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Provider Business Mailing Address
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Address Line | 498 HARLOW RD STE 3
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City | SPRINGFIELD
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State | OR
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Zip | 97477-1339
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Country | US
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Telephone | 541-341-1414
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Fax | 541-653-8570
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | JARED WILSON
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Credential | DC, CCSP
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Telephone | 541-341-1414
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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 | 3956
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License Number State | OR
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