Healthcare Provider Details

I. General information

NPI: 1093859308
Provider Name (Legal Business Name): NANCY PEDERSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6881 S HOLLY CIRCLE SUITE 207
CENTENNIAL CO
80112-1145
US

IV. Provider business mailing address

20128 E DARTMOUTH DR
AURORA CO
80013-8434
US

V. Phone/Fax

Practice location:
  • Phone: 303-221-3600
  • Fax: 720-529-0222
Mailing address:
  • Phone: 303-221-3600
  • Fax: 720-529-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4172
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: