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General NPI Number Information
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NPI Number | 1699968271
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC LIFESTYLES, PC
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 11605 MERIDIAN MARKET VW SUITE # 142
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City | PEYTON
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State | CO
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Zip | 80831-8237
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Country | US
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Telephone | 719-475-2455
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Fax | 719-475-2254
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Provider Business Mailing Address
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Address Line | 2812 W COLORADO AVE SUITE # 104
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-2470
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Country | US
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Telephone | 719-475-2455
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Fax | 719-475-2254
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Authorized Official
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Title or Position | OPERATOR
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Name | DR. JASON W. CAHILL
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Credential | DC
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Telephone | 719-475-2455
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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 | 3993
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License Number State | CO
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