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General NPI Number Information
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NPI Number | 1306182407
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Entity Type | Organization
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Legal Business Name | ZANDI CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 12/17/2012
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 3400 TABLE MESA DR SUITE 201
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City | BOULDER
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State | CO
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Zip | 80305-5869
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Country | US
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Telephone | 518-593-5583
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 TABLE MESA DR SUITE 201
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City | BOULDER
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State | CO
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Zip | 80305-5869
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Country | US
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Telephone | 518-593-5583
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. SEPEHR ZANDI
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Credential | DC
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Telephone | 518-593-5583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 6816
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License Number State | CO
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