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General NPI Number Information
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NPI Number | 1639457393
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Entity Type | Organization
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Legal Business Name | ASPEN FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 07/29/2011
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Provider Practice Location Address
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Address Line | 312 STEELE ST
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City | LARAMIE
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State | WY
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Zip | 82070-4454
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Country | US
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Telephone | 307-760-6863
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Fax |
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Provider Business Mailing Address
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Address Line | 312 STEELE ST
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City | LARAMIE
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State | WY
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Zip | 82070-4454
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Country | US
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Telephone | 307-760-6863
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MANDY J JAIRELL
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Credential | DC
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Telephone | 307-760-6863
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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 | 711
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License Number State | WY
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