=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750501235
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINETIC BODY IN BALANCE A COLORADO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 12/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5935 S ZANG ST STE. 275
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-4647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-933-9149
-----------------------------------------------------
Fax | 303-933-9110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5935 S ZANG ST STE. 275
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-4647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-933-9149
-----------------------------------------------------
Fax | 303-933-9110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. ZACHARY RYAN SNYDER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 303-933-9149
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5996
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5997
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------