=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710230958
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CALLIE RENEE STILWELL D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2012
-----------------------------------------------------
Last Update Date | 06/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9660 E ALAMEDA AVE STE 101
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-363-9095
-----------------------------------------------------
Fax | 303-363-6794
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9660 E ALAMEDA AVE STE 101
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80247-1448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-363-9095
-----------------------------------------------------
Fax | 303-363-6794
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC010655
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHR0007037
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------