=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518361716
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPRINGS CHIROPRACTIC, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2014
-----------------------------------------------------
Last Update Date | 10/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1802 CHAPEL HILLS DR SUITE E
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-3765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-531-7188
-----------------------------------------------------
Fax | 719-531-0880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1802 CHAPEL HILLS DR SUITE E
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-3765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-531-7188
-----------------------------------------------------
Fax | 719-531-0880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | LESLIE S HOLT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 719-531-7188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MT0016705
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------