MEDICARE: PROLIFIC 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	4716	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TR658937	OTHER	CO	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1225067929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROLIFIC CHIROPRACTIC, P.C.

Provider Business Mailing Address
First Line	:	2323 S TROY ST
Second Line	:	SUITE 2-105
City	:	AURORA
State	:	CO
Zip	:	80014-1946
Country	:	US
Telephone Number	:	303-337-1321
Fax Number	:	303-337-2305

Provider Business Practice Location Address
First Line	:	2323 S TROY ST
Second Line	:	SUITE 2-105
City	:	AURORA
State	:	CO
Zip	:	80014-1946
Country	:	US
Telephone Number	:	303-337-1321
Fax Number	:	303-337-2305

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROECHELLE LAVETTE SMITH
Credential	:	D.C.
Telephone Number	:	303-337-1321

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	08/22/2020

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