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General NPI Number Information
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NPI Number | 1063740397
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Entity Type | Organization
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Legal Business Name | MFCC CORP.
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 3560 S BANNOCK ST
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City | ENGLEWOOD
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State | CO
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Zip | 80110-3626
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Country | US
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Telephone | 303-797-8850
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Fax | 303-797-1378
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Provider Business Mailing Address
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Address Line | 3560 S BANNOCK ST
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City | ENGLEWOOD
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State | CO
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Zip | 80110-3626
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Country | US
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Telephone | 303-797-8850
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Fax | 303-797-1378
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY W MORTIMER
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Credential | D.C.
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Telephone | 303-797-8850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3478
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License Number State | CO
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