MEDICARE: INJURY CENTER OF COLORADO. 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	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1245727635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INJURY CENTER OF COLORADO. LLC

Provider Business Mailing Address
First Line	:	441 WADSWORTH BLVD STE 206
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-1546
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 WADSWORTH BLVD STE 206
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-1546
Country	:	US
Telephone Number	:	281-933-3399
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PHUC K HUYNH
Credential	:	DC
Telephone Number	:	281-933-3399

Provider Enumeration Date	:	04/20/2018
Last Update Date	:	04/20/2018

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