Healthcare Provider Details

I. General information

NPI: 1063684777
Provider Name (Legal Business Name): TRANSFORMATION CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6854 S DALLAS WAY
GREENWOOD VILLAGE CO
80112-3621
US

IV. Provider business mailing address

6854 S DALLAS WAY
GREENWOOD VILLAGE CO
80112-3621
US

V. Phone/Fax

Practice location:
  • Phone: 303-741-0990
  • Fax: 303-741-0991
Mailing address:
  • Phone: 303-741-0990
  • Fax: 303-741-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.0005073
License Number StateCO

VIII. Authorized Official

Name: DR. CHRIS PELLOW
Title or Position: OWNER
Credential: DC
Phone: 303-741-0990