Healthcare Provider Details

I. General information

NPI: 1255501003
Provider Name (Legal Business Name): PEDERSON CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6881 S HOLLY CIR 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:
Mailing address:
  • Phone: 303-221-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NANCY PEDERSON
Title or Position: OWNER
Credential: D.C.
Phone: 303-221-3600