Provider Demographics
NPI:1003513565
Name:SUMMIT CHIROPRACTIC AND WELLNESS LLC
Entity type:Organization
Organization Name:SUMMIT CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-460-9922
Mailing Address - Street 1:1262 N 22ND ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-5307
Mailing Address - Country:US
Mailing Address - Phone:307-460-9922
Mailing Address - Fax:307-370-4124
Practice Address - Street 1:1262 N 22ND ST UNIT C
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-5307
Practice Address - Country:US
Practice Address - Phone:307-460-9922
Practice Address - Fax:307-370-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty