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General NPI Number Information
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NPI Number | 1598718025
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Entity Type | Individual
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Provider Name | RYAN KELLEY PROBASCO D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 12170 TEJON ST STE 400
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City | WESTMINSTER
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State | CO
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Zip | 80234-2341
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Country | US
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Telephone | 303-429-0011
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Fax | 303-429-8001
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Provider Business Mailing Address
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Address Line | 12170 TEJON ST STE 400
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City | WESTMINSTER
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State | CO
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Zip | 80234-2341
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Country | US
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Telephone | 303-429-0011
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Fax | 303-429-8001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4859
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License Number State | CO
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