Provider Demographics
NPI:1437803541
Name:100 CHIRO WALFOORT LLC
Entity Type:Organization
Organization Name:100 CHIRO WALFOORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIRORACTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALFOORT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-316-5024
Mailing Address - Street 1:1021 N MARKET PLZ STE 102
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1532
Mailing Address - Country:US
Mailing Address - Phone:719-252-8184
Mailing Address - Fax:719-547-1188
Practice Address - Street 1:1021 N MARKET PLZ STE 102
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-1532
Practice Address - Country:US
Practice Address - Phone:719-252-8184
Practice Address - Fax:719-547-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty