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General NPI Number Information
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NPI Number | 1891001087
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Entity Type | Organization
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Legal Business Name | MOUNTAIN SHADOWS CHIROPRACTIC & REHABILITATION, INC
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 120 MIDLAND AVE #230
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601
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Country | US
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Telephone | 970-384-2240
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Fax |
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Provider Business Mailing Address
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Address Line | 120 MIDLAND AVE #230
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. ERRIK ENEWOLD
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Credential | DC
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Telephone | 970-384-2240
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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 | 6105
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License Number State | CO
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