MEDICARE: DONALD E DURANSO 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	111NN1001X	Nutrition Chiropractor	3903	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M36049	OTHER	CO	WORK COMP

General Provider Information

NPI Number	:	1285622027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD E DURANSO D.C.

Provider Business Mailing Address
First Line	:	5265 N ACADEMY BLVD
Second Line	:	STE 1100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4042
Country	:	US
Telephone Number	:	719-597-7553
Fax Number	:	719-597-7554

Provider Business Practice Location Address
First Line	:	5265 N ACADEMY BLVD
Second Line	:	STE 1100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4042
Country	:	US
Telephone Number	:	719-597-7553
Fax Number	:	719-597-7554

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	05/09/2012

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