MEDICARE: BASECAMP WELLNESS MANAGEMENT GROUP, LLC

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	:	1598349391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASECAMP WELLNESS MANAGEMENT GROUP, LLC

Provider Business Mailing Address
First Line	:	1698 COUNTY RD
Second Line	:
City	:	MINDEN
State	:	NV
Zip	:	89423-4405
Country	:	US
Telephone Number	:	937-232-5434
Fax Number	:

Provider Business Practice Location Address
First Line	:	1698 COUNTY RD
Second Line	:
City	:	MINDEN
State	:	NV
Zip	:	89423-4405
Country	:	US
Telephone Number	:	937-232-5434
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CAYLA LAIRMORE
Credential	:	DC
Telephone Number	:	937-232-5434

Provider Enumeration Date	:	05/07/2021
Last Update Date	:	05/07/2021

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