Healthcare Provider Details

I. General information

NPI: 1124231592
Provider Name (Legal Business Name): GOLD CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6851 S. HOLLY CIR. SUITE 110
CENTENNIAL CO
80112-1532
US

IV. Provider business mailing address

6851 S HOLLY CIR SUITE 110
CENTENNIAL CO
80112-1019
US

V. Phone/Fax

Practice location:
  • Phone: 303-798-2000
  • Fax:
Mailing address:
  • Phone: 303-798-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4592
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number4592
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4592
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4592
License Number StateCO

VIII. Authorized Official

Name: DR. SHANE GOLD
Title or Position: OWNER
Credential:
Phone: 303-798-2000