Healthcare Provider Details

I. General information

NPI: 1134367931
Provider Name (Legal Business Name): DOUGLAS WAYNE KLOSS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E CACHE LA POUDRE ST
COLORADO SPRINGS CO
80903-2958
US

IV. Provider business mailing address

213 E CACHE LA POUDRE ST
COLORADO SPRINGS CO
80903-2958
US

V. Phone/Fax

Practice location:
  • Phone: 719-667-1007
  • Fax: 719-630-7683
Mailing address:
  • Phone: 719-667-1007
  • Fax: 719-630-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.6897
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: