MEDICARE: ROBERT J SPARROW D.C.

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	1969	CO

General Provider Information

NPI Number	:	1225102692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J SPARROW D.C.

Provider Business Mailing Address
First Line	:	PO BOX 1476
Second Line	:
City	:	IDAHO SPRINGS
State	:	CO
Zip	:	80452-1476
Country	:	US
Telephone Number	:	303-567-9211
Fax Number	:	303-567-9212

Provider Business Practice Location Address
First Line	:	1800 COLORADO BLVD.
Second Line	:	SUITE 8
City	:	IDAHO SPRINGS
State	:	CO
Zip	:	80452-1476
Country	:	US
Telephone Number	:	303-567-9211
Fax Number	:	303-567-9212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	04/26/2010

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