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General NPI Number Information
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NPI Number | 1588114987
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE OF HIGHLANDS RANCH WEST LLC.
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 9249 S BROADWAY UNIT 100
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-5690
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Country | US
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Telephone | 303-470-1020
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Fax | 303-470-1702
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Provider Business Mailing Address
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Address Line | 9249 S BROADWAY UNIT 100
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-5690
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Country | US
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Telephone | 303-470-1020
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Fax | 303-470-1702
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Authorized Official
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Title or Position | PARTNER
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Name | DR. SHANNON HURLEY
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Credential | D.C.
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Telephone | 303-470-1020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 20161654184
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License Number State | CO
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