MEDICARE: HAPPY RIVER, 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	5597	CO

General Provider Information

NPI Number	:	1265618052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAPPY RIVER, LLC.

Provider Business Mailing Address
First Line	:	110 W HARVARD ST
Second Line	:	STE 2
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5217
Country	:	US
Telephone Number	:	970-282-1173
Fax Number	:	970-282-1175

Provider Business Practice Location Address
First Line	:	110 W HARVARD ST
Second Line	:	STE 2
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5217
Country	:	US
Telephone Number	:	970-282-1173
Fax Number	:	970-282-1175

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BENJAMIN L GALYARDT
Credential	:	D.C.
Telephone Number	:	970-282-1173

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	04/02/2014

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