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General NPI Number Information
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NPI Number | 1215061908
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Entity Type | Organization
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Legal Business Name | A AND A CHIROPRACTIC CENTER LLC
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 635 W CORONA AVE SUITE 103
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City | PUEBLO
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State | CO
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Zip | 81004-1242
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Country | US
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Telephone | 719-543-3433
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Fax | 719-543-5036
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Provider Business Mailing Address
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Address Line | 635 W CORONA AVE SUITE 103
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City | PUEBLO
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State | CO
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Zip | 81004-1242
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Country | US
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Telephone | 719-543-3433
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Fax | 719-543-5036
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TANO EDWARD WELCH
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Credential | DC
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Telephone | 719-543-3433
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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 | 2439
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License Number State | CO
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