Provider Demographics
NPI:1437971348
Name:LOUISVILLE CHIROPRACTIC & WELLNESS, LLC
Entity type:Organization
Organization Name:LOUISVILLE CHIROPRACTIC & WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-704-5376
Mailing Address - Street 1:333 WEST SOUTH BOULDER ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027
Mailing Address - Country:US
Mailing Address - Phone:720-457-9509
Mailing Address - Fax:720-861-0979
Practice Address - Street 1:333 WEST SOUTH BOULDER ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027
Practice Address - Country:US
Practice Address - Phone:720-457-9509
Practice Address - Fax:720-861-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty