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General NPI Number Information
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NPI Number | 1396255568
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Entity Type | Organization
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Legal Business Name | COLORADO SPORTS CHIROPRACTIC
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 06/07/2019
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Provider Practice Location Address
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Address Line | 1440 28TH ST STE 2
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City | BOULDER
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State | CO
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Zip | 80303
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Country | US
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Telephone | 303-736-9343
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Fax | 844-872-5595
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Provider Business Mailing Address
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Address Line | 1440 28TH ST STE 2
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City | BOULDER
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State | CO
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Zip | 80303-1030
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Country | US
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Telephone | 303-736-9343
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Fax | 844-872-5595
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN MICHAEL MINEN
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Credential | DC
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Telephone | 303-736-9343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CHR.0007584
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License Number State | CO
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