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General NPI Number Information
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NPI Number | 1891466207
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Entity Type | Organization
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Legal Business Name | MOUNTAIN SPORTS CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/24/2021
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 270 E 8TH AVE # N202
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City | DURANGO
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State | CO
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Zip | 81301-5708
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Country | US
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Telephone | 970-403-5759
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Fax |
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Provider Business Mailing Address
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Address Line | 270 E 8TH AVE # N202
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City | DURANGO
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State | CO
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Zip | 81301-5708
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Country | US
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Telephone | 970-403-5759
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. DIANA C MILLER
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Credential | DC
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Telephone | 970-403-5759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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