Healthcare Provider Details

I. General information

NPI: 1164178620
Provider Name (Legal Business Name): ADAPT SPORTS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 E HARMONY RD UNIT 17
FORT COLLINS CO
80528-3414
US

IV. Provider business mailing address

PO BOX 272450
FORT COLLINS CO
80527-2450
US

V. Phone/Fax

Practice location:
  • Phone: 970-290-5220
  • Fax:
Mailing address:
  • Phone: 970-290-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAWN SMALL
Title or Position: OWNER
Credential: DC
Phone: 970-290-5220