| Ediss Chiropractic, Inc | |
|
1330 E Richards St, Douglas, WY 82633-2951 | |
| (307) 358-3147 | |
| (307) 358-3213 |
| Full Name | Ediss Chiropractic, Inc |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 1330 E Richards St, Douglas, Wyoming |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477736015 | NPI | - | NPPES |
| 03753001 | Other | BCBS CLINIC | |
| 0554501 | Other | WY | WORKERS COMPENSATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | 574 (Wyoming) | Primary |
| Provider Name | Stephan P Ediss |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1669521324 PECOS PAC ID: 0446411268 Enrollment ID: I20120420000593 |
| Mailing Address | Practice Location Address |
|---|---|
| Ediss Chiropractic, Inc 1330 E Richards St, P.o. Box 902, Douglas, WY 82633-2951 Ph: (307) 358-3147 | Ediss Chiropractic, Inc 1330 E Richards St, Douglas, WY 82633-2951 Ph: (307) 358-3147 |
Dr. Stephan Paul Ediss, D.C. Chiropractor Medicare: May Accept Medicare Assignments Practice Location: 1330 E. Richards, Douglas, WY 82633 Phone: 307-358-3147 Fax: 307-358-3213 | |
Dr. Robert D Keeler, D.C. Chiropractor Medicare: Medicare Enrolled Practice Location: 1843 Madora Ave, Douglas, WY 82633 Phone: 307-358-4418 Fax: 307-358-5390 |