MEDICARE: NEURAPERFORMANCE BRAIN CENTER 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	:	1487134136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURAPERFORMANCE BRAIN CENTER LLC

Provider Business Mailing Address
First Line	:	3486 YOUNGFIELD ST
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-5245
Country	:	US
Telephone Number	:	303-274-4434
Fax Number	:	303-274-4441

Provider Business Practice Location Address
First Line	:	2899 N SPEER BLVD UNIT 105
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-4217
Country	:	US
Telephone Number	:	303-350-0637
Fax Number	:	303-274-4441

Authorized Official
Title or Position	:	DC/OWNER
Name	:	SHAWN MICHEL CALDWELL
Credential	:	DC
Telephone Number	:	303-274-4434

Provider Enumeration Date	:	08/21/2018
Last Update Date	:	08/21/2018

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