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General NPI Number Information
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NPI Number | 1346546033
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Entity Type | Organization
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Legal Business Name | PRATT CHIROPRACTIC
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 3023 W NORTHERN AVE
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City | PUEBLO
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State | CO
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Zip | 81005-2316
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Country | US
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Telephone | 719-564-0461
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Fax | 719-566-8600
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Provider Business Mailing Address
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Address Line | 3023 W NORTHERN AVE
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City | PUEBLO
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State | CO
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Zip | 81005-2316
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Country | US
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Telephone | 719-564-0461
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Fax | 719-566-8600
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Authorized Official
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Title or Position | DR./OWNER
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Name | ROBERT A PRATT
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Credential | DC
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Telephone | 719-564-0461
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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 | 2764
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License Number State | CO
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