Healthcare Provider Details

I. General information

NPI: 1437668670
Provider Name (Legal Business Name): TIMOTHY DANIEL CONWELL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 UMATILLA ST.
DENVER CO
80211
US

IV. Provider business mailing address

4444 UMATILLA ST.
DENVER CO
80211
US

V. Phone/Fax

Practice location:
  • Phone: 720-982-8088
  • Fax:
Mailing address:
  • Phone: 720-982-8088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number1730
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: