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General NPI Number Information
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NPI Number | 1114358355
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Entity Type | Organization
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Legal Business Name | FORM AND FUNCTION CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 13751 E YALE AVE
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City | AURORA
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State | CO
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Zip | 80014-7351
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Country | US
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Telephone | 303-597-9595
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Fax | 303-597-9689
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Provider Business Mailing Address
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Address Line | 1041 S HOLLY ST
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City | DENVER
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State | CO
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Zip | 80246-2307
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Country | US
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Telephone | 970-988-0328
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. MATTHEW LEROY USEL
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Credential | DC
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Telephone | 970-988-0328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0006782
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License Number State | CO
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