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NPI Code Detail

MEDICARE: DR. JOHN L. DAUGHERTY DC

MEDICARE: DR. JOHN L. DAUGHERTY DC
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
1111N00000XChiropractor2843CO

General Provider Information

NPI Number : 1164632444
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN L. DAUGHERTY DC
Provider Business Mailing Address
First Line : 1923 W COLORADO AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80904-3838
Country : US
Telephone Number : 719-635-4022
Fax Number : 719-635-4735
Provider Business Practice Location Address
First Line : 1923 W COLORADO AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80904-3838
Country : US
Telephone Number : 719-635-4022
Fax Number : 719-635-4735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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