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NPI Code Detail

MEDICARE: CHIROPRACTIC SPORTS & WELLNESS PC

MEDICARE: CHIROPRACTIC SPORTS & WELLNESS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor650WY

General Provider Information

NPI Number : 1114216082
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHIROPRACTIC SPORTS & WELLNESS PC
Provider Business Mailing Address
First Line : 1021 E LINCOLNWAY
Second Line :
City : CHEYENNE
State : WY
Zip : 82001-4851
Country : US
Telephone Number : 307-635-7727
Fax Number : 307-638-0423
Provider Business Practice Location Address
First Line : 1021 E LINCOLNWAY
Second Line :
City : CHEYENNE
State : WY
Zip : 82001-4851
Country : US
Telephone Number : 307-635-7727
Fax Number : 307-638-0423
Authorized Official
Title or Position : OWNER
Name : PAUL ROMEO CASSISTA
Credential : D.C.
Telephone Number : 307-635-7727
Provider Enumeration Date : 03/31/2011
Last Update Date : 03/31/2011

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Directions to “CHIROPRACTIC SPORTS & WELLNESS PC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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