=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205089638
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEADOWS SPORTS & SPINE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2008
-----------------------------------------------------
Last Update Date | 10/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2942 EVERGREEN PKWY STE 200
-----------------------------------------------------
City | EVERGREEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80439-2223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-679-8870
-----------------------------------------------------
Fax | 303-679-3498
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2942 EVERGREEN PKWY STE 200
-----------------------------------------------------
City | EVERGREEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80439-2223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-679-8870
-----------------------------------------------------
Fax | 303-679-3498
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOSEPH C SILVERNAIL
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 303-679-8870
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 5438
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------