Healthcare Provider Details

I. General information

NPI: 1386237360
Provider Name (Legal Business Name): KENNETH SPENCER STEFFEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5032 FIFTH AVE.
TIMNATH CO
80547-8054
US

IV. Provider business mailing address

PO BOX 272
TIMNATH CO
80547-0272
US

V. Phone/Fax

Practice location:
  • Phone: 970-573-9015
  • Fax:
Mailing address:
  • Phone: 641-799-9851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHR.0007556
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: