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General NPI Number Information
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NPI Number | 1245473636
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Entity Type | Organization
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Legal Business Name | CHAMPION CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 04/14/2009
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Last Update Date | 04/14/2009
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Provider Practice Location Address
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Address Line | 700 E MAIN ST
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City | MONTROSE
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State | CO
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Zip | 81401-3975
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Country | US
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Telephone | 970-249-4213
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Fax | 970-240-8094
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Provider Business Mailing Address
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Address Line | PO BOX 3623
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City | MONTROSE
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State | CO
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Zip | 81402-3623
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Country | US
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Telephone | 970-249-4213
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Fax | 970-240-8094
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MS. COLLEEN ANN KRAHL
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Credential | D.C.
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Telephone | 970-249-4213
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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 |
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License Number State |
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