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General NPI Number Information
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NPI Number | 1801132725
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Entity Type | Organization
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Legal Business Name | KEYSTONE CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 12/20/2012
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 621 17TH ST STE 1720
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City | DENVER
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State | CO
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Zip | 80293-1701
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Country | US
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Telephone | 720-508-3627
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Fax |
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Provider Business Mailing Address
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Address Line | 621 17TH ST STE 1720
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City | DENVER
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State | CO
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Zip | 80293-1701
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Country | US
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Telephone | 720-508-3627
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MICHAEL ANTHONY O'BRIEN
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Credential | D.C.
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Telephone | 720-231-5063
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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 | 4786
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License Number State | CO
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