MEDICARE: WOW FAMILY CHIROPRACTIC, INC

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
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1366913261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOW FAMILY CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	7150 CAMPUS DR STE 230
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3177
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7150 CAMPUS DR STE 230
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3177
Country	:	US
Telephone Number	:	719-627-4969
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN DAVIS
Credential	:	DC
Telephone Number	:	719-627-4969

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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