=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194190322
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPRINGS INTEGRATED HEALTH PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2015
-----------------------------------------------------
Last Update Date | 09/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1465 KELLY JOHNSON BLVD STE 110
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-3945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-445-6077
-----------------------------------------------------
Fax | 719-323-6242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1465 KELLY JOHNSON BLVD STE 110
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-3945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-445-6077
-----------------------------------------------------
Fax | 719-323-6242
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. TIFFANY GRAHAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 719-761-0221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------