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General NPI Number Information
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NPI Number | 1215056577
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Entity Type | Individual
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Provider Name | BASIL EUGENE PEARSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1311 S 9TH ST
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City | CANON CITY
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State | CO
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Zip | 81212-4207
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Country | US
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Telephone | 719-275-1611
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Fax | 719-275-2226
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Provider Business Mailing Address
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Address Line | PO BOX 1717 1311 SO. 9TH ST.
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City | CANON CITY
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State | CO
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Zip | 81215-1717
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Country | US
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Telephone | 719-275-1611
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Fax | 719-275-2226
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1174
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License Number State | CO
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