Longevity Chiropractic, LLC
Chiropractor, Rehabilitation in Pueblo, CO. Organization (NPI-2).
NPI number1174875298
StatusActive
Last updated in NPPESOct 4, 2019
Details
- NPI
- 1174875298
- Entity type
- Organization (NPI-2)
- Legal business name
- Longevity Chiropractic, LLC
- Organization subpart
- No
- Enumeration date
- Oct 12, 2012
- Last updated
- Oct 4, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 111NR0400X | Chiropractor, Rehabilitation | 6888 | CO | Yes |
| 111NN0400X | Chiropractor, Neurology | 6888 | CO | |
| 111NP0017X | Chiropractor, Pediatric Chiropractor | 6891 | CO | |
| 111NS0005X | Chiropractor, Sports Physician | 6888 | CO |
Practice location
2447 S Prairie AvePueblo, CO 81005
Phone 254-394-0836
Mailing address
1504 Sandpiper PlPueblo, CO 81006-9751
Phone 254-394-0836
Authorized official
Derek Wade Stickler
Owner/Manager
2543940836
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