Provider Demographics
NPI:1669741203
Name:CLOUD PEAK CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:CLOUD PEAK CHIROPRACTIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RADABAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-347-3500
Mailing Address - Street 1:618 COBURN AVE
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-3314
Mailing Address - Country:US
Mailing Address - Phone:307-347-3500
Mailing Address - Fax:307-347-4893
Practice Address - Street 1:618 COBURN AVE
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-3314
Practice Address - Country:US
Practice Address - Phone:307-347-3500
Practice Address - Fax:307-347-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2023-03-01
Deactivation Date:2023-01-17
Deactivation Code:
Reactivation Date:2023-03-01
Provider Licenses
StateLicense IDTaxonomies
WY670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty