MEDICARE: SHIFT POWERED BY CHIROPRACTIC LLC

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	:	1427382662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIFT POWERED BY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2501 15TH ST UNIT 1C
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3986
Country	:	US
Telephone Number	:	303-433-0933
Fax Number	:	303-433-1679

Provider Business Practice Location Address
First Line	:	2501 15TH ST UNIT 1C
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3986
Country	:	US
Telephone Number	:	303-433-0933
Fax Number	:	303-433-1679

Authorized Official
Title or Position	:	OWNER
Name	:	MARCO VESPA
Credential	:	DC
Telephone Number	:	303-433-0933

Provider Enumeration Date	:	09/21/2009
Last Update Date	:	09/21/2009

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