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General NPI Number Information
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NPI Number | 1497245005
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Entity Type | Organization
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Legal Business Name | CORDELL CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 400 W MAIN ST
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City | LYONS
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State | KS
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Zip | 67554-1819
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Country | US
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Telephone | 970-219-8647
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Fax | 620-257-2038
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Provider Business Mailing Address
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Address Line | PO BOX 235
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City | LYONS
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State | KS
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Zip | 67554-0235
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Country | US
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Telephone | 970-219-8647
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Fax | 620-257-2038
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERESA CORDELL
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Credential | DC
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Telephone | 970-219-8647
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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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Taxonomy #2
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Taxonomy Code | 111NI0900X
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Taxonomy Name | Internist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition
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License Number |
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License Number State |
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