1487019139 NPI number — EPIC CHIROPRACTIC OF CASPER LLC

Table of content: (NPI 1487019139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487019139 NPI number — EPIC CHIROPRACTIC OF CASPER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EPIC CHIROPRACTIC OF CASPER LLC
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:
1487019139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3211 ENERGY LN
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82604-2941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-224-2244
Provider Business Mailing Address Fax Number:
855-777-3613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3211 ENERGY LN
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82604-2941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-224-2244
Provider Business Practice Location Address Fax Number:
855-777-3613
Provider Enumeration Date:
12/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MUNOZ
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
GENE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-408-5685

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  742 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com