=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568414159
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARWIN LEE STJERNHOLM DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2006
-----------------------------------------------------
Last Update Date | 07/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11911 N HIGHWAY 83 SUITE 109
-----------------------------------------------------
City | PARKER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80134-9073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-841-1860
-----------------------------------------------------
Fax | 303-841-9095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11911 N HIGHWAY 83 SUITE 109
-----------------------------------------------------
City | PARKER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80134-9073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-618-6088
-----------------------------------------------------
Fax | 303-646-2474
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number | 3244
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------