MEDICARE: PRIME CHIROPRACTIC INC

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	:	1396634184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	5956 S HOLLY ST
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-4221
Country	:	US
Telephone Number	:	720-676-6440
Fax Number	:

Provider Business Practice Location Address
First Line	:	5956 S HOLLY ST
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-4221
Country	:	US
Telephone Number	:	720-676-6440
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATTHEW PENNETTI
Credential	:	DC
Telephone Number	:	720-676-6440

Provider Enumeration Date	:	06/28/2025
Last Update Date	:	06/28/2025

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Directions to “PRIME CHIROPRACTIC INC ” Practice Location

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