NPIMap

Organization Active NPI

Spine & Injury Clinic of Laramie, PC

  • Chiropractor
  • Laramie, WY
National Provider Identifier
1902097637
Registry record updated Oct 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
663 Issued in WY
Legal business name
SPINE & INJURY CLINIC OF LARAMIE, PC
Practice address
3905 E Grand Ave Ste 200
Laramie, WY 82070-5189
Phone
(307) 742-2082
Fax
(307) 742-2075
NPI assigned
Aug 7, 2007
Last updated
Oct 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2022

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

Authorized official

Name
Kelly Milam
Title
Practice Manager
Phone
(307) 742-2082

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X
Chiropractor 111N00000X 663 WY Primary
Sports Physician Chiropractor 111NS0005X
Physical Therapist 225100000X
Sports Physical Therapist 2251S0007X
Orthopedic Physical Therapist 2251X0800X

Addresses

Primary practice location

3905 E Grand Ave Ste 200
Laramie, WY 82070-5189

Mailing address

3905 E Grand Ave Ste 200
Laramie, WY 82070-5189
Phone (307) 742-2082

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080401000909 WY Part B Supplier - Clinic/Group Practice 0941387997 Receives reassigned benefits from 10 practitioners
Practice locations: Laramie, WY

National Provider Directory

National Provider Directory

Locations

3905 E Grand Ave
Ste 200
Laramie, WY 82070
Phone (307) 742-2082

409 S 4th St
Laramie, WY 82070
Phone (307) 742-2082

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1902097637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3905 E GRAND AVE STE 200",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705189",
            "telephone_number": "307-742-2082",
            "fax_number": "307-742-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3905 E GRAND AVE STE 200",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705189",
            "telephone_number": "307-742-2082",
            "fax_number": "307-742-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE & INJURY CLINIC OF LARAMIE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-07",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "MILAM",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "307-742-2082"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WY",
            "license": "663",
            "primary": true
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laramie, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; 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.