MEDICARE: GENESIS CHIROPRACTIC

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

General Provider Information

NPI Number	:	1265569248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS CHIROPRACTIC

Provider Business Mailing Address
First Line	:	7200 E HAMPDEN AVE STE 103
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80224-3021
Country	:	US
Telephone Number	:	303-758-2638
Fax Number	:	303-758-2633

Provider Business Practice Location Address
First Line	:	7200 E HAMPDEN AVE STE 103
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80224-3021
Country	:	US
Telephone Number	:	303-758-2638
Fax Number	:	303-758-2633

Authorized Official
Title or Position	:	OWNER
Name	:	MS. RAE LYNN RIEDEL
Credential	:	D.C.
Telephone Number	:	303-758-2638

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/13/2013

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Directions to “GENESIS CHIROPRACTIC ” Practice Location

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