=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255513438
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHELLE MEINHOLZ D.C., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2007
-----------------------------------------------------
Last Update Date | 11/29/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4150 DARLEY AVE SUITE 6
-----------------------------------------------------
City | BOULDER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80305-6557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-499-5000
-----------------------------------------------------
Fax | 303-499-4962
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4150 DARLEY AVE SUITE 6
-----------------------------------------------------
City | BOULDER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80305-6557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-499-5000
-----------------------------------------------------
Fax | 303-499-4962
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHELLE LEE MEINHOLZ
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 563-320-4833
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 6101
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------