MEDICARE: MEDICAL RESTORATION CENTERS, 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	207Q00000X	Family Medicine Physician	16337	CO

General Provider Information

NPI Number	:	1821334137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL RESTORATION CENTERS, LLC

Provider Business Mailing Address
First Line	:	4760 FLINTRIDGE DR
Second Line	:	SUITE 150
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4267
Country	:	US
Telephone Number	:	719-266-0438
Fax Number	:

Provider Business Practice Location Address
First Line	:	4760 FLINTRIDGE DR
Second Line	:	SUITE 150
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4267
Country	:	US
Telephone Number	:	719-266-0438
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ALLAN NEIL GERMAN
Credential	:	D.C.
Telephone Number	:	719-266-0438

Provider Enumeration Date	:	12/14/2012
Last Update Date	:	12/14/2012

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