=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760665079
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOOTHILLS CHIROPRACTIC & WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2007
-----------------------------------------------------
Last Update Date | 09/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7610 S ALKIRE PL UNIT B
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-3211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-933-6153
-----------------------------------------------------
Fax | 303-933-9431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7610 S ALKIRE PL UNIT B
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-3211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-933-6153
-----------------------------------------------------
Fax | 303-933-9431
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. DARCY ALLISON KOEHN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 303-933-6153
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 6130
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------