=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780708461
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY L SELANO DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 03/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6726 S REVERE PKWY STE 180
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-3962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-681-6170
-----------------------------------------------------
Fax | 720-928-5516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6726 S REVERE PKWY STE 180
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-3962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-681-6170
-----------------------------------------------------
Fax | 720-928-5516
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR005181
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHR.00007356
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------