MEDICARE: ABSOLUTE CHIROPRACTIC P.C.

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	1287	CO

General Provider Information

NPI Number	:	1174733687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABSOLUTE CHIROPRACTIC P.C.

Provider Business Mailing Address
First Line	:	2472 F ROAD
Second Line	:	UNIT 6
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1205
Country	:	US
Telephone Number	:	970-242-0280
Fax Number	:	970-242-6463

Provider Business Practice Location Address
First Line	:	2472 F ROAD
Second Line	:	UNIT 6
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1205
Country	:	US
Telephone Number	:	970-242-0280
Fax Number	:	970-242-6463

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONALD WAYNE CANNON
Credential	:	D.C.
Telephone Number	:	970-242-0280

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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