MEDICARE: ASPEN PARK CHIROPRACTIC & MASSAGE CENTER

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	225700000X	Massage Therapist	4431	CO
2	225700000X	Massage Therapist	6523	CO
3	111N00000X	Chiropractor	3874	CO

General Provider Information

NPI Number	:	1952699761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPEN PARK CHIROPRACTIC & MASSAGE CENTER

Provider Business Mailing Address
First Line	:	12424 BIG TIMBER DR
Second Line	:	UNIT 4
City	:	CONIFER
State	:	CO
Zip	:	80433-6410
Country	:	US
Telephone Number	:	303-838-8443
Fax Number	:	303-838-7794

Provider Business Practice Location Address
First Line	:	12424 BIG TIMBER DR
Second Line	:	UNIT 4
City	:	CONIFER
State	:	CO
Zip	:	80433-6410
Country	:	US
Telephone Number	:	303-838-8443
Fax Number	:	303-838-7794

Authorized Official
Title or Position	:	OWNER
Name	:	JEANNE ZAFFT GIBSON
Credential	:	CMT
Telephone Number	:	303-838-8443

Provider Enumeration Date	:	07/13/2011
Last Update Date	:	07/13/2011

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