Organization
PURE SPA & WELLNESS
Active
Organization
PURE SPA & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TAD DORSEY CHILDERS LCMT (MEDICAL MASSAGE THERAPIST)
(719) 582-1432
Entity
Organization
Contact information
Practice address
279 S PURCELL BLVD STE 100, PUEBLO WEST, CO 81007-5083
(719) 582-1432
Mailing address
279 S PURCELL BLVD STE 100, PUEBLO WEST, CO 81007-5083
(719) 582-1432
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT.0006794
CO
Other
Enumeration date
03/07/2016
Last updated
03/07/2016
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