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General NPI Number Information
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NPI Number | 1780086181
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Entity Type | Organization
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Legal Business Name | KEYSTONE HEALTH & WELLNESS CENTER INC
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Dates
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Enumeration Date | 09/17/2014
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 8765 E ORCHARD RD STE 702
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-5009
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Country | US
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Telephone | 303-738-0390
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Fax | 866-238-2721
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Provider Business Mailing Address
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Address Line | 8765 E ORCHARD RD STE 702
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-5009
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Country | US
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Telephone | 303-738-0390
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Fax | 866-238-2721
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SHAWN JOHONNESSON
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Credential |
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Telephone | 303-709-4805
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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