MEDICARE: CROSSROADS CHIROPRACTIC INC

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	3057	CO

General Provider Information

NPI Number	:	1144538646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	755 NORTH AVE
Second Line	:	UNIT D
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-3152
Country	:	US
Telephone Number	:	970-241-9008
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 NORTH AVE
Second Line	:	UNIT D
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-3152
Country	:	US
Telephone Number	:	970-241-9008
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JON HANSEN
Credential	:	DC
Telephone Number	:	970-241-9008

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	12/03/2010

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