MEDICARE: MONGILLO FAMILY 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

General Provider Information

NPI Number	:	1194597575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONGILLO FAMILY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	11873 SPRINGS RD STE 125
Second Line	:
City	:	CONIFER
State	:	CO
Zip	:	80433-7263
Country	:	US
Telephone Number	:	720-773-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	11873 SPRINGS RD STE 125
Second Line	:
City	:	CONIFER
State	:	CO
Zip	:	80433-7263
Country	:	US
Telephone Number	:	720-773-2500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSHUA D MONGILLO
Credential	:	DC
Telephone Number	:	720-773-2500

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	10/27/2023

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