=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083097448
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH ZDANOWSKI D. C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2015
-----------------------------------------------------
Last Update Date | 07/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1440 W 29TH ST SUITE 200
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-2459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-667-4669
-----------------------------------------------------
Fax | 303-557-6321
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1440 W 29TH ST SUITE 200
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-2459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-667-4669
-----------------------------------------------------
Fax | 303-557-6321
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHR0007137
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------