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General NPI Number Information
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NPI Number | 1184800757
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Entity Type | Organization
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Legal Business Name | STILL POINT MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 1430 S. 21ST STREET SUITE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-4279
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Country | US
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Telephone | 719-385-0600
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Fax | 719-385-0601
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Provider Business Mailing Address
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Address Line | 1430 S. 21ST STREET SUITE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-4279
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Country | US
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Telephone | 719-385-0600
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Fax | 719-385-0601
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. ADRIENNE MARIE KANIA
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Credential | DO
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Telephone | 719-385-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 31196
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License Number State | CO
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