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General NPI Number Information
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NPI Number | 1659798213
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Entity Type | Organization
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Legal Business Name | CASTLE ROCK CHIROPRACTIC
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 03/20/2014
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Provider Practice Location Address
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Address Line | 4284 TRAIL BOSS DR STE 120
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City | CASTLE ROCK
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State | CO
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Zip | 80104-7521
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Country | US
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Telephone | 719-369-9506
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Fax |
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Provider Business Mailing Address
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Address Line | 4284 TRAIL BOSS DR STE 120
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City | CASTLE ROCK
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State | CO
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Zip | 80104-7521
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Country | US
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Telephone | 719-369-9506
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | BRANDON JAMES ALLISON
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Credential | D.C.
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Telephone | 719-369-9506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHR.0007115
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License Number State | CO
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