=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770359374
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TWO & FOUR CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2023
-----------------------------------------------------
Last Update Date | 11/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 TABOR ST ROOM 104
-----------------------------------------------------
City | BUENA VISTA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-204-3566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30880 COUNTY ROAD 356-6
-----------------------------------------------------
City | BUENA VISTA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81211-8616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-562-0683
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CALLIE JORDAN GARLICK
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 724-562-0683
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------