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General NPI Number Information
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NPI Number | 1356660047
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Entity Type | Organization
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Legal Business Name | BEE EXTRAORDINARY LLC CHIROPRACTIC WELLNESS SOLUTIONS
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 4540 GUNBARREL DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80925-1036
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Country | US
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Telephone | 719-648-5920
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Fax |
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Provider Business Mailing Address
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Address Line | 4540 GUNBARREL DRIVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80925
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Country | US
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Telephone | 719-648-5920
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. KELLY L WOOD
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Credential | DC
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Telephone | 719-648-5920
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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 | CHR4260
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License Number State | CO
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