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General NPI Number Information
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NPI Number | 1386937951
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Entity Type | Organization
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Legal Business Name | PORTENIER CHIROPRACTIC, PC
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 05/16/2011
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Provider Practice Location Address
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Address Line | 7373 W JEFFERSON AVE STE 402
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City | LAKEWOOD
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State | CO
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Zip | 80235-2051
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Country | US
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Telephone | 303-972-0800
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Fax | 303-972-4132
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Provider Business Mailing Address
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Address Line | 7373 W JEFFERSON AVE STE 402
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City | LAKEWOOD
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State | CO
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Zip | 80235-2051
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Country | US
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Telephone | 303-972-0800
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Fax | 303-972-4132
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN RALPH PORTENIER
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Credential | D.C.
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Telephone | 303-972-0800
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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 | 3218
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License Number State | CO
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