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General NPI Number Information
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NPI Number | 1912192832
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Entity Type | Organization
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Legal Business Name | PAGOSA CHIROPRACTIC
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 705 SAN JUAN STREET
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147
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Country | US
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Telephone | 970-264-2604
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 967
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-0967
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Country | US
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Telephone | 970-264-2604
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT ANDERSON
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Credential | D.C.
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Telephone | 970-264-2604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2385
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License Number State | CO
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