Organization
LONGEVITY CHIROPRACTIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEREK WADE STICKLER D.C. (OWNER/MANAGER)
(254) 394-0836
Entity
Organization
Contact information
Practice address
2447 S PRAIRIE AVE, PUEBLO, CO 81005
(254) 394-0836
Mailing address
1504 SANDPIPER PL, PUEBLO, CO 81006-9751
(254) 394-0836
Taxonomy
Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
6888
CO
111NP0017X
Pediatric Chiropractor
6891
CO
111NR0400X
Rehabilitation Chiropractor
Primary
6888
CO
111NS0005X
Sports Physician Chiropractor
6888
CO
Other
Enumeration date
10/12/2012
Last updated
10/04/2019
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