Healthcare Provider Details

I. General information

NPI: 1043635790
Provider Name (Legal Business Name): HOLY CROSS CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 PINE STREET
MINTURN CO
81645
US

IV. Provider business mailing address

PO BOX 1131
MINTURN CO
81645-1131
US

V. Phone/Fax

Practice location:
  • Phone: 970-688-5842
  • Fax:
Mailing address:
  • Phone: 970-688-5842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5798
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number5798
License Number StateCO

VIII. Authorized Official

Name: DR. CHRISTOPHER ROCKWELL DAVIS
Title or Position: OWNER
Credential: D.C.
Phone: 970-688-5842