=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376872598
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANANDA WELLNESS CENTERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2009
-----------------------------------------------------
Last Update Date | 08/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2727 BRYANT ST STE 500
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80211-4153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-379-3519
-----------------------------------------------------
Fax | 720-524-3472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2727 BRYANT ST. STE. 500
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-379-3519
-----------------------------------------------------
Fax | 720-524-3472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JARED C GRUHL
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 720-379-3519
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 6076
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------