MEDICARE: MUSOLF 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	4246	CO

General Provider Information

NPI Number	:	1164509915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSOLF CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	5582 TIMELESS VW
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-1497
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8540 SCARBOROUGH DR STE 370
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7519
Country	:	US
Telephone Number	:	719-471-2225
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	ELISE L MUSOLF
Credential	:	DC
Telephone Number	:	719-471-2225

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/31/2019

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