Provider Demographics
NPI:1548680440
Name:WESTERN PLAINS CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:WESTERN PLAINS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MILES
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-682-6650
Mailing Address - Street 1:900 EZ ST STE 120
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5969
Mailing Address - Country:US
Mailing Address - Phone:307-682-6650
Mailing Address - Fax:307-682-1814
Practice Address - Street 1:900 EZ ST STE 120
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5969
Practice Address - Country:US
Practice Address - Phone:307-682-6650
Practice Address - Fax:307-682-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-18
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty