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General NPI Number Information
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NPI Number | 1396172961
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Entity Type | Organization
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Legal Business Name | CHRIS BANTOCK DC, LLC
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 4500 CHERRY CREEK DRIVE SOUTH SUITE 103
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City | GLENDALE
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State | CO
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Zip | 80246
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Country | US
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Telephone | 303-518-8117
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 CHERRY CREEK DRIVE SOUTH SUITE 103
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City | GLENDALE
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State | CO
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Zip | 80246
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Country | US
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Telephone | 303-518-8117
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. CHRISTOPHER FLOYD BANTOCK
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Credential | D.C.
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Telephone | 303-518-8117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CHR.0006985
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License Number State | CO
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