Provider Demographics
NPI:1386962553
Name:WILEY CHIROPRACTIC GROUP P. C.
Entity type:Organization
Organization Name:WILEY CHIROPRACTIC GROUP P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-589-5163
Mailing Address - Street 1:511 MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2672
Mailing Address - Country:US
Mailing Address - Phone:719-589-5163
Mailing Address - Fax:719-589-8988
Practice Address - Street 1:511 MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2672
Practice Address - Country:US
Practice Address - Phone:719-589-5163
Practice Address - Fax:719-589-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1181111N00000X, 111NN1001X, 111NP0017X, 111NR0200X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty