Provider Demographics
NPI:1477726206
Name:INSPIRED CHIROPRACTIC AND WELLNESS, PC
Entity Type:Organization
Organization Name:INSPIRED CHIROPRACTIC AND WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PEDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-559-8119
Mailing Address - Street 1:13550 NORTHGATE ESTATES DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7653
Mailing Address - Country:US
Mailing Address - Phone:719-599-8119
Mailing Address - Fax:719-599-0958
Practice Address - Street 1:13550 NORTHGATE ESTATES DR
Practice Address - Street 2:SUITE 210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-7653
Practice Address - Country:US
Practice Address - Phone:719-599-8119
Practice Address - Fax:719-599-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-13
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty