Provider Demographics
NPI:1487019139
Name:EPIC CHIROPRACTIC OF CASPER LLC
Entity Type:Organization
Organization Name:EPIC CHIROPRACTIC OF CASPER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-408-5685
Mailing Address - Street 1:3211 ENERGY LN
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-2941
Mailing Address - Country:US
Mailing Address - Phone:307-224-2244
Mailing Address - Fax:855-777-3613
Practice Address - Street 1:3211 ENERGY LN
Practice Address - Street 2:SUITE 301
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-2941
Practice Address - Country:US
Practice Address - Phone:307-224-2244
Practice Address - Fax:855-777-3613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY742111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW25974Medicare PIN