Healthcare Provider Details

I. General information

NPI: 1306037544
Provider Name (Legal Business Name): DAZAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
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 Number
License Number State

VIII. Authorized Official

Name: DR. ANGELA DEE PRICE KLOSS
Title or Position: MANAGING MEMBER
Credential: D.C.
Phone: 719-667-1007