Healthcare Provider Details

I. General information

NPI: 1336664366
Provider Name (Legal Business Name): KAITLYN J POPP DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3729 W 32ND AVE
DENVER CO
80211-3121
US

IV. Provider business mailing address

4410 W 34TH AVE
DENVER CO
80212-1748
US

V. Phone/Fax

Practice location:
  • Phone: 303-916-1064
  • Fax:
Mailing address:
  • Phone: 847-894-7454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHR.0007633
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: