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General NPI Number Information
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NPI Number | 1407307523
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Entity Type | Organization
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Legal Business Name | CORE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 4730 CENTENNIAL BLVD 102
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-3338
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Country | US
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Telephone | 719-258-8349
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Fax |
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Provider Business Mailing Address
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Address Line | 4730 CENTENNIAL BLVD 102
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-3338
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Country | US
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Telephone | 719-217-7453
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAILE RYAN MYRICK
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Credential | D.C.
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Telephone | 719-217-7453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CHR.0007486
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License Number State | CO
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