Provider Demographics
NPI:1902155146
Name:HEALTHSOURCE OF GILLETTE INC.
Entity Type:Organization
Organization Name:HEALTHSOURCE OF GILLETTE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-670-9426
Mailing Address - Street 1:110 E LAKEWAY RD
Mailing Address - Street 2:STE 1000
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6365
Mailing Address - Country:US
Mailing Address - Phone:307-670-9426
Mailing Address - Fax:307-257-2569
Practice Address - Street 1:110 E LAKEWAY RD
Practice Address - Street 2:STE 1000
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6365
Practice Address - Country:US
Practice Address - Phone:307-670-9426
Practice Address - Fax:307-257-2569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY703111N00000X, 111NR0400X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty