=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841320017
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE BACK EXPERT PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 11/03/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4024 S PARKER RD
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80014-4131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-627-7995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4024 S PARKER RD
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80014-4131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-627-7995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HOLLY REDE GEERSEN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 303-627-7995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | 5527
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------