MEDICARE: SAND CREEK CHIROPRACTIC GROUP

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	111NN1001X	Nutrition Chiropractor	3903	CO

General Provider Information

NPI Number	:	1063782530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAND CREEK CHIROPRACTIC GROUP

Provider Business Mailing Address
First Line	:	5265N ACADEMY BLVD
Second Line	:	STE 1100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4042
Country	:	US
Telephone Number	:	719-597-7553
Fax Number	:	719-597-7554

Provider Business Practice Location Address
First Line	:	5265N ACADEMY BLVD
Second Line	:	STE 1100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4042
Country	:	US
Telephone Number	:	719-597-7553
Fax Number	:	719-597-7554

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DONALD E DURANSO
Credential	:	DO
Telephone Number	:	719-597-7553

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	01/13/2012

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