Organization Active NPI

Pueblo West Chiropractic Center Inc.

  • Chiropractor
  • Pueblo West, CO
National Provider Identifier
1770799744
Registry record updated Sep 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CO4489 Issued in CO
Legal business name
PUEBLO WEST CHIROPRACTIC CENTER INC.
Practice address
171 S Purcell Blvd
Pueblo West, CO 81007-5081
Phone
(719) 547-1979
Fax
(719) 547-7336
NPI assigned
May 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Angela Elaine Vik, D.C.
Title
Co-Owner
Phone
(719) 547-1979

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X CO4489 CO Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X CO4091 CO

Addresses

Primary practice location

171 S Purcell Blvd
Pueblo West, CO 81007-5081

Mailing address

171 S Purcell Blvd
Pueblo West, CO 81007-5081
Phone (719) 547-1979

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081229000448 CO Part B Supplier - Clinic/Group Practice 2163584111 Receives reassigned benefits from 1 practitioner
Practice locations: Pueblo West, CO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380499200000",
    "number": "1770799744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 S PURCELL BLVD",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810075081",
            "telephone_number": "719-547-1979",
            "fax_number": "719-547-7336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 S PURCELL BLVD",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810075081",
            "telephone_number": "719-547-1979",
            "fax_number": "719-547-7336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO WEST CHIROPRACTIC CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2013-09-30",
        "status": "A",
        "authorized_official_last_name": "VIK",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "719-547-1979",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "CO",
            "license": "CO4489",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "CO",
            "license": "CO4091",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo West, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.