Healthcare Provider Details

I. General information

NPI: 1619218856
Provider Name (Legal Business Name): CARBON VALLEY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MAIN STREET SUITE A
FREDERICK CO
80530
US

IV. Provider business mailing address

630 MAIN STREET SUITE A
FREDERICK CO
80530-0858
US

V. Phone/Fax

Practice location:
  • Phone: 303-833-1500
  • Fax:
Mailing address:
  • Phone: 303-833-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4399
License Number StateCO

VIII. Authorized Official

Name: DR. LAWRENCE M FEINMAN
Title or Position: OWNER
Credential: DC
Phone: 303-833-1500