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General NPI Number Information
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NPI Number | 1780866764
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Entity Type | Organization
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Legal Business Name | AVON CHIROPRACTIC HEALTH CENTER
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 150 E. BEAVER CREEK BLVD 106B
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City | AVON
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State | CO
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Zip | 81620
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Country | US
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Telephone | 970-949-0444
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 109
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City | AVON
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State | CO
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Zip | 81620-0109
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Country | US
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Telephone | 970-949-0444
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. THOMAS CRISOFULLI
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Credential | D.C.
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Telephone | 970-949-0444
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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 | 3921
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License Number State | CO
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