Healthcare Provider Details

I. General information

NPI: 1144331919
Provider Name (Legal Business Name): DAVID KEITH POWELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 RAMPART RANGE RD
WOODLAND PARK CO
80863-2429
US

IV. Provider business mailing address

PO BOX 5176
WOODLAND PARK CO
80866-5176
US

V. Phone/Fax

Practice location:
  • Phone: 719-687-6096
  • Fax: 719-687-9623
Mailing address:
  • Phone: 719-687-6096
  • Fax: 719-687-9623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2946
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: