Healthcare Provider Details

I. General information

NPI: 1861749160
Provider Name (Legal Business Name): DENVER SPORTS AND FAMILY CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 S. JACKSON ST SUITE 810
DENVER CO
80210-3801
US

IV. Provider business mailing address

1776 S. JACKSON ST SUITE 810
DENVER CO
80210-3801
US

V. Phone/Fax

Practice location:
  • Phone: 303-500-3414
  • Fax: 303-997-1054
Mailing address:
  • Phone: 303-500-3414
  • Fax: 303-997-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number6634
License Number StateCO

VIII. Authorized Official

Name: DR. CARLY MAY
Title or Position: OWNER
Credential: DC
Phone: 303-500-3414