MEDICARE: THE CHIRO CONNECTION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4597	CO

General Provider Information

NPI Number	:	1144423583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHIRO CONNECTION, LLC

Provider Business Mailing Address
First Line	:	3425 AUSTIN BLUFFS PKWY
Second Line	:	SUITE 110
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5701
Country	:	US
Telephone Number	:	719-630-0254
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 AUSTIN BLUFFS PKWY
Second Line	:	SUITE 110
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5701
Country	:	US
Telephone Number	:	719-630-0254
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. TYRONE DAVID JOHNSON
Credential	:	D.C
Telephone Number	:	719-630-0254

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/22/2020

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