MEDICARE: INNOVATIVE 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	6925	CO

General Provider Information

NPI Number	:	1265897466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	5800 E EVANS AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-5311
Country	:	US
Telephone Number	:	720-588-5147
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 E EVANS AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-5311
Country	:	US
Telephone Number	:	720-588-5147
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RANDY KYLE GILKAY
Credential	:	D.C.
Telephone Number	:	720-588-5147

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	12/15/2015

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Directions to “INNOVATIVE CHIROPRACTIC ” Practice Location

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