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General NPI Number Information
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NPI Number | 1306717137
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Entity Type | Organization
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Legal Business Name | LEGACY LIFE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 180 E HAMPDEN AVE
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City | ENGLEWOOD
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State | CO
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Zip | 80113-2506
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Country | US
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Telephone | 505-573-4246
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Fax |
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Provider Business Mailing Address
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Address Line | 16658 E 101ST AVE
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City | COMMERCE CITY
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State | CO
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Zip | 80022-8878
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Country | US
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Telephone | 505-573-4246
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRANDI PORTER
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Credential | DC
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Telephone | 505-573-4246
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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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