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General NPI Number Information
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NPI Number | 1518311646
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Entity Type | Organization
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Legal Business Name | ONE HUNDRED PERCENT CHIROPRACTIC FORT COLLINS ONE LLC
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 4532 MCMURRY AVE SUITE 120
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City | FORT COLLINS
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State | CO
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Zip | 80525-8022
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Country | US
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Telephone | 970-294-4150
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Fax | 970-286-2913
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Provider Business Mailing Address
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Address Line | 4532 MCMURRY AVE SUITE 120
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City | FORT COLLINS
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State | CO
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Zip | 80525-8022
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Country | US
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Telephone | 970-294-4150
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Fax | 970-286-2913
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Authorized Official
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Title or Position | OWNER/CEO
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Name | CALVIN JACOB MAYES
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Credential | D.C
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Telephone | 303-503-7525
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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.0007427
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License Number State | CO
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