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General NPI Number Information
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NPI Number | 1346296779
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Entity Type | Organization
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Legal Business Name | MODRELL FAMILY AND SPORTS CHIROPRACTIC, INC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 05/03/2010
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Provider Practice Location Address
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Address Line | 1550 E NIAGARA RD
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City | MONTROSE
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State | CO
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Zip | 81401-5689
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Country | US
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Telephone | 970-240-4500
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Fax | 970-240-4897
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Provider Business Mailing Address
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Address Line | 1550 NIAGARA RD
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City | MONTROSE
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State | CO
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Zip | 81401-5027
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Country | US
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Telephone | 970-240-4500
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Fax | 970-240-4897
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Authorized Official
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Title or Position | OWNER CHIROPRACTOR
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Name | DR. COREY MODRELL
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Credential | DC
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Telephone | 970-240-4500
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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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