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General NPI Number Information
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NPI Number | 1437803541
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Entity Type | Organization
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Legal Business Name | 100 CHIRO WALFOORT LLC
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 1021 N MARKET PLZ STE 102
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City | PUEBLO WEST
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State | CO
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Zip | 81007-1532
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Country | US
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Telephone | 719-252-8184
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Fax | 719-547-1188
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Provider Business Mailing Address
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Address Line | 1021 N MARKET PLZ STE 102
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City | PUEBLO WEST
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State | CO
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Zip | 81007-1532
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Country | US
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Telephone | 719-252-8184
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Fax | 719-547-1188
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Authorized Official
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Title or Position | CHIRORACTOR / OWNER
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Name | DR. LORA WALFOORT
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Credential | DC
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Telephone | 602-316-5024
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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 |
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License Number State |
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