Provider Demographics
NPI:1093902223
Name:PRATER VIEW CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:PRATER VIEW CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BREE
Authorized Official - Middle Name:
Authorized Official - Last Name:NINCEHELSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-883-7246
Mailing Address - Street 1:PO BOX 1179
Mailing Address - Street 2:
Mailing Address - City:THAYNE
Mailing Address - State:WY
Mailing Address - Zip Code:83127-1179
Mailing Address - Country:US
Mailing Address - Phone:307-883-7246
Mailing Address - Fax:307-883-7247
Practice Address - Street 1:118 S MAIN ST
Practice Address - Street 2:STE 400
Practice Address - City:THAYNE
Practice Address - State:WY
Practice Address - Zip Code:83127-1179
Practice Address - Country:US
Practice Address - Phone:307-883-7246
Practice Address - Fax:307-883-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY673111N00000X, 261Q00000X
WY707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW21582Medicare PIN