Provider Demographics
NPI:1992991368
Name:LARAMIE COUNTY CHIROPRACTIC
Entity type:Organization
Organization Name:LARAMIE COUNTY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-638-0894
Mailing Address - Street 1:800 E 20TH ST STE 240
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3868
Mailing Address - Country:US
Mailing Address - Phone:307-638-0894
Mailing Address - Fax:307-638-0895
Practice Address - Street 1:800 E 20TH ST STE 240
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3868
Practice Address - Country:US
Practice Address - Phone:307-638-0894
Practice Address - Fax:307-638-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120243000Medicaid
WYW10241Medicare PIN