=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881875441
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN VIEW CHIROPRACTIC AND WELLNESS CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2007
-----------------------------------------------------
Last Update Date | 01/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18801 E MAINSTREET STE 190
-----------------------------------------------------
City | PARKER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80134-3477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-841-9565
-----------------------------------------------------
Fax | 303-600-9630
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18801 E MAINSTREET STE 190
-----------------------------------------------------
City | PARKER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80134-3477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-841-9565
-----------------------------------------------------
Fax | 303-600-9630
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PARTNER
-----------------------------------------------------
Name | ROBERT L BIRCH
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 303-841-9565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5582
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------