Healthcare Provider Details

I. General information

NPI: 1184800757
Provider Name (Legal Business Name): STILL POINT MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 S. 21ST STREET SUITE 100
COLORADO SPRINGS CO
80904-4279
US

IV. Provider business mailing address

1430 S. 21ST STREET SUITE 100
COLORADO SPRINGS CO
80904-4279
US

V. Phone/Fax

Practice location:
  • Phone: 719-385-0600
  • Fax: 719-385-0601
Mailing address:
  • Phone: 719-385-0600
  • Fax: 719-385-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number31196
License Number StateCO

VIII. Authorized Official

Name: DR. ADRIENNE MARIE KANIA
Title or Position: PRESIDENT/OWNER
Credential: DO
Phone: 719-385-0600