1477726206 NPI number — INSPIRED CHIROPRACTIC AND WELLNESS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477726206 NPI number — INSPIRED CHIROPRACTIC AND WELLNESS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSPIRED CHIROPRACTIC AND WELLNESS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477726206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13550 NORTHGATE ESTATES DR
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80921-7653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-599-8119
Provider Business Mailing Address Fax Number:
719-599-0958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13550 NORTHGATE ESTATES DR
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80921-7653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-599-8119
Provider Business Practice Location Address Fax Number:
719-599-0958
Provider Enumeration Date:
04/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PEDERSEN
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
719-559-8119

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3879 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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