Healthcare Provider Details

I. General information

NPI: 1184551913
Provider Name (Legal Business Name): WELL ROOTED WELLNESS GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 PINEWICKET WAY
PARKER CO
80138-4411
US

IV. Provider business mailing address

642 PINEWICKET WAY
PARKER CO
80138-4411
US

V. Phone/Fax

Practice location:
  • Phone: 720-263-0256
  • Fax:
Mailing address:
  • Phone: 720-263-0256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLE DAVIS
Title or Position: OWNER
Credential: DC
Phone: 720-263-0256