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General NPI Number Information
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NPI Number | 1841518594
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Entity Type | Organization
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Legal Business Name | PINEDALE CHIROPRACTIC CENTER P.C.
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Dates
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Enumeration Date | 05/05/2010
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 423 W. PINE
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City | PINEDALE
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State | WY
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Zip | 82941
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Country | US
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Telephone | 307-367-4147
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Fax | 307-367-6610
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Provider Business Mailing Address
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Address Line | PO BOX 1547
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City | PINEDALE
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State | WY
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Zip | 82941-1547
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Country | US
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Telephone | 307-367-4147
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Fax | 307-367-6610
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Authorized Official
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Title or Position | OFFICE MANAGER/BOOK KEEPER
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Name | JACLYN NELSON
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Credential |
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Telephone | 307-367-4147
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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 | WY
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