Healthcare Provider Details

I. General information

NPI: 1003858838
Provider Name (Legal Business Name): SCOTTING CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 FORESIGHT CIR UNIT D
GRAND JUNCTION CO
81505-1007
US

IV. Provider business mailing address

2505 FORESIGHT CIR UNIT D
GRAND JUNCTION CO
81505-1007
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-9001
  • Fax:
Mailing address:
  • Phone: 970-242-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4644
License Number StateCO

VIII. Authorized Official

Name: RYAN SCOTTING
Title or Position: MANAGER
Credential: D.C.
Phone: 970-242-9001