Provider Demographics
NPI:1548488851
Name:CASPER MOUNTAIN CHIROPRACTIC LLC
Entity type:Organization
Organization Name:CASPER MOUNTAIN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:1307-473-1000
Mailing Address - Street 1:5850 EAST 2ND STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609
Mailing Address - Country:US
Mailing Address - Phone:307-473-1000
Mailing Address - Fax:307-473-1014
Practice Address - Street 1:5850 EAST 2ND STREET
Practice Address - Street 2:SUITE B
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609
Practice Address - Country:US
Practice Address - Phone:307-473-1000
Practice Address - Fax:307-473-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty