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General NPI Number Information
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NPI Number | 1104616887
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Entity Type | Organization
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Legal Business Name | MOUNTAINSIDE FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 6565 W JEWELL AVE STE 12A
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City | LAKEWOOD
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State | CO
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Zip | 80232-7102
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Country | US
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Telephone | 303-484-8136
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Fax | 303-484-8371
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Provider Business Mailing Address
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Address Line | 6565 W JEWELL AVE STE 12A
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City | LAKEWOOD
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State | CO
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Zip | 80232-7102
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Country | US
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Telephone | 303-484-8136
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Fax | 303-484-8371
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMANDA KELLEY
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Credential | DC
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Telephone | 303-484-8136
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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 |
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License Number State |
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