MEDICARE: ACTION SPINE & SPORTS MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	CHR.0006855	CO

General Provider Information

NPI Number	:	1043762636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTION SPINE & SPORTS MEDICINE

Provider Business Mailing Address
First Line	:	2209 LARIMER ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-2094
Country	:	US
Telephone Number	:	720-541-7098
Fax Number	:	720-278-7866

Provider Business Practice Location Address
First Line	:	2209 LARIMER ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-2094
Country	:	US
Telephone Number	:	720-541-7098
Fax Number	:	720-278-7866

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BENJAMIN R COWIN
Credential	:	DC, MS, ATC
Telephone Number	:	720-541-7098

Provider Enumeration Date	:	10/29/2016
Last Update Date	:	10/29/2016

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Directions to “ACTION SPINE & SPORTS MEDICINE ” Practice Location

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