Healthcare Provider Details

I. General information

NPI: 1063782530
Provider Name (Legal Business Name): SAND CREEK CHIROPRACTIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5265N ACADEMY BLVD STE 1100
COLORADO SPRINGS CO
80918-4042
US

IV. Provider business mailing address

5265N ACADEMY BLVD STE 1100
COLORADO SPRINGS CO
80918-4042
US

V. Phone/Fax

Practice location:
  • Phone: 719-597-7553
  • Fax: 719-597-7554
Mailing address:
  • Phone: 719-597-7553
  • Fax: 719-597-7554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number3903
License Number StateCO

VIII. Authorized Official

Name: DR. DONALD E DURANSO
Title or Position: OWNER
Credential: DO
Phone: 719-597-7553