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General NPI Number Information
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NPI Number | 1932224367
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Entity Type | Organization
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Legal Business Name | BACKROADS CHIROPRACTIC PC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 716 W BROOKSIDE ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-2073
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Country | US
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Telephone | 719-475-9103
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Fax | 719-475-2225
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Provider Business Mailing Address
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Address Line | 716 W BROOKSIDE ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-2073
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Country | US
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Telephone | 719-475-9103
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Fax | 719-475-2225
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIANE LYNN ELWER
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Credential | D.C.
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Telephone | 719-475-9103
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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 | 6017
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License Number State | CO
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