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General NPI Number Information
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NPI Number | 1700708922
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE LIFE MD
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 315 CANYON AVE STE 2A
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City | FORT COLLINS
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State | CO
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Zip | 80521-2686
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Country | US
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Telephone | 970-598-5012
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Fax |
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Provider Business Mailing Address
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Address Line | 814 W MOUNTAIN AVE
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City | FORT COLLINS
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State | CO
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Zip | 80521-2508
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Country | US
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Telephone | 512-296-0319
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SHELLEY W MOORE
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Credential | MD
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Telephone | 512-296-0319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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