Provider Demographics
NPI:1104479252
Name:TRAILHEAD CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:TRAILHEAD CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-456-4562
Mailing Address - Street 1:51241 HIGHWAY 6 STE 8B
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-2588
Mailing Address - Country:US
Mailing Address - Phone:970-456-4562
Mailing Address - Fax:
Practice Address - Street 1:51241 HIGHWAY 6 STE 8B
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-2588
Practice Address - Country:US
Practice Address - Phone:970-456-4562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty