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General NPI Number Information
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NPI Number | 1518324599
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Entity Type | Organization
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Legal Business Name | 307 CHIROPRACTIC HEALTH CENTER PC
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Dates
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Enumeration Date | 01/22/2016
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 5880 E 2ND ST STE 200
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City | CASPER
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State | WY
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Zip | 82609-4388
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Country | US
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Telephone | 307-575-2448
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Fax |
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Provider Business Mailing Address
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Address Line | 5880 E 2ND ST STE 200
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City | CASPER
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State | WY
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Zip | 82609-4388
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AUSTEN WISROTH
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Credential | D.C.
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Telephone | 307-575-2448
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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 | 759
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License Number State | WY
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