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General NPI Number Information
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NPI Number | 1578966206
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Entity Type | Organization
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Legal Business Name | CONSCIOUS SOL HEALING & WELLNESS CENTER
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | 400 E SIMPSON ST
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City | LAFAYETTE
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State | CO
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Zip | 80026-2394
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Country | US
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Telephone | 720-560-5022
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Fax |
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Provider Business Mailing Address
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Address Line | 904 CLOVER CIR
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City | LAFAYETTE
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State | CO
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Zip | 80026-1772
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Country | US
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Telephone | 720-560-5022
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/PRESIDENT
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Name | JODI HODGES
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Credential | D.C.
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Telephone | 720-560-5022
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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 | CHR0007046
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License Number State | CO
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