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General NPI Number Information
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NPI Number | 1144256264
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Entity Type | Organization
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Legal Business Name | TELLER COUNTY CHIROPRACTIC
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 800 E US HIGHWAY 24 SUITE D
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City | WOODLAND PARK
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State | CO
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Zip | 80863-7754
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Country | US
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Telephone | 719-687-1881
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Fax | 719-687-9408
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Provider Business Mailing Address
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Address Line | 800 E US HIGHWAY 24 SUITE D
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City | WOODLAND PARK
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State | CO
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Zip | 80863-7754
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Country | US
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Telephone | 719-687-1881
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | DR. CHRISTOPHER L. MIRABELLA
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Credential | D.C.
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Telephone | 719-687-1881
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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 | 5875
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License Number State | CO
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