MEDICARE: PEAK POTENTIAL CHIROPRACTIC, LLC

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	0006999	CO

General Provider Information

NPI Number	:	1114325008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK POTENTIAL CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	862 W HAPPY CANYON RD
Second Line	:	SUITE 100
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-3910
Country	:	US
Telephone Number	:	720-612-4389
Fax Number	:	720-612-4689

Provider Business Practice Location Address
First Line	:	862 W HAPPY CANYON RD
Second Line	:	SUITE 100
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-3910
Country	:	US
Telephone Number	:	720-612-4389
Fax Number	:	720-612-4689

Authorized Official
Title or Position	:	OWNER
Name	:	MEGAN FOWLER
Credential	:	D.C.
Telephone Number	:	720-612-4386

Provider Enumeration Date	:	12/09/2014
Last Update Date	:	12/09/2014

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