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General NPI Number Information
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NPI Number | 1265820955
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Entity Type | Organization
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Legal Business Name | PEARL STREET CHIROPRACTIC
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 1073 S PEARL ST SUITE 101
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City | DENVER
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State | CO
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Zip | 80209-4225
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Country | US
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Telephone | 303-919-8007
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Fax |
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Provider Business Mailing Address
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Address Line | 1073 S PEARL ST SUITE 101
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City | DENVER
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State | CO
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Zip | 80209-4225
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Country | US
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Telephone | 303-919-8007
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICAELA O'CONNOR
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Credential | D.C.
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Telephone | 303-919-8007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CHR 0007224
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License Number State | CO
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