Healthcare Provider Details

I. General information

NPI: 1487867073
Provider Name (Legal Business Name): SOPRIS CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E VALLEY RD STE, 202A
BASALT CO
81621-8370
US

IV. Provider business mailing address

711 E VALLEY RD STE, 202A
BASALT CO
81621-8370
US

V. Phone/Fax

Practice location:
  • Phone: 970-927-9204
  • Fax: 970-927-9238
Mailing address:
  • Phone: 970-927-9204
  • Fax: 970-927-9238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SCOTT J. TESORO
Title or Position: OWNER
Credential: D.C.
Phone: 970-927-9204