=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164545638
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MTN HEALTH CHIRO & NEUROLOGY CTR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 12/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3646 SOUTH GALAPAGO STREET
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-781-5617
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3646 SOUTH GALAPAGO STREET
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80110-3421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-781-5617
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAVID GLENN ARTHUR
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 303-781-5617
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN0400X
-----------------------------------------------------
Taxonomy Name | Neurology Chiropractor
-----------------------------------------------------
License Number | 5464
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------