Provider Demographics
NPI:1568793800
Name:BIG COUNTRY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:BIG COUNTRY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-856-4400
Mailing Address - Street 1:611 E MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4423
Mailing Address - Country:US
Mailing Address - Phone:307-856-4400
Mailing Address - Fax:307-856-9723
Practice Address - Street 1:611 E MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4423
Practice Address - Country:US
Practice Address - Phone:307-856-4400
Practice Address - Fax:307-856-9723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY110371700Medicaid
WY302330OtherBLUE CROSS BLUE SHIELD OF WYOMING
WYT44198Medicare UPIN