MEDICARE: OTTERSBERG CHIROPRACTIC PC

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	261Q00000X	Clinic/Center	2420	CO

General Provider Information

NPI Number	:	1558561225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTTERSBERG CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	3055 E HWY 50
Second Line	:	SUITE C
City	:	CANON CITY
State	:	CO
Zip	:	81212-2775
Country	:	US
Telephone Number	:	719-269-1020
Fax Number	:

Provider Business Practice Location Address
First Line	:	3055 E HWY 50
Second Line	:	SUITE C
City	:	CANON CITY
State	:	CO
Zip	:	81212-2775
Country	:	US
Telephone Number	:	719-269-1020
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM J OTTERSBERG JR.
Credential	:	D.C.
Telephone Number	:	719-269-1020

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	12/04/2007

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