MEDICARE: DR. DOUG DEVINE D.C.

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	111N00000X	Chiropractor	CHR.0007201	CO

General Provider Information

NPI Number	:	1053717637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUG DEVINE D.C.

Provider Business Mailing Address
First Line	:	2330 CENTRAL PARK BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-3234
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 CENTRAL PARK BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-3234
Country	:	US
Telephone Number	:	720-536-0707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	11/10/2014

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