Provider Demographics
NPI:1578809885
Name:AMPERSAND WELLNESS LLC
Entity Type:Organization
Organization Name:AMPERSAND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BERGQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-344-2121
Mailing Address - Street 1:3472 RESEARCH PKWY # 104-203
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1066
Mailing Address - Country:US
Mailing Address - Phone:719-344-2121
Mailing Address - Fax:719-694-1480
Practice Address - Street 1:1304 N ACADEMY BLVD STE 208
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3318
Practice Address - Country:US
Practice Address - Phone:719-344-2121
Practice Address - Fax:719-694-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.00004418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty