Provider Demographics
NPI:1396801908
Name:HEALING ELEMENT CHIROPRACTIC LLC
Entity type:Organization
Organization Name:HEALING ELEMENT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FAUBION
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-856-6612
Mailing Address - Street 1:PO BOX 1457
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-0160
Mailing Address - Country:US
Mailing Address - Phone:307-856-6612
Mailing Address - Fax:307-856-1767
Practice Address - Street 1:621 N 10TH ST E
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2906
Practice Address - Country:US
Practice Address - Phone:307-856-6612
Practice Address - Fax:307-856-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY645261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW21379Medicare PIN