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General NPI Number Information
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NPI Number | 1164774436
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Entity Type | Organization
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Legal Business Name | KROESE CHIROPRACTIC PC
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 535 16TH ST STE 200
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City | DENVER
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State | CO
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Zip | 80202-4261
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Country | US
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Telephone | 303-371-5280
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Fax | 303-623-0446
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Provider Business Mailing Address
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Address Line | 7352 E 7TH AVE UNIT 8
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City | DENVER
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State | CO
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Zip | 80230-6226
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Country | US
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Telephone | 972-835-9697
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON L KROESE
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Credential | D.C.
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Telephone | 972-835-9697
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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 | 6747
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License Number State | CO
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