Healthcare Provider Details

I. General information

NPI: 1972860161
Provider Name (Legal Business Name): 100 PERCENT CHIROPRACTIC DENVER THREE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 E COUNTY LINE RD UNIT G
LITTLETON CO
80126-2439
US

IV. Provider business mailing address

2030 E COUNTY LINE RD UNIT G
LITTLETON CO
80126-2439
US

V. Phone/Fax

Practice location:
  • Phone: 719-667-1007
  • Fax: 719-630-7683
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6779
License Number StateCO

VIII. Authorized Official

Name: MATTHEW THOMPSON
Title or Position: CHIROPRACTOR
Credential:
Phone: 719-667-1007