MEDICARE: ANANDA WELLNESS CENTERS, 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	6076	CO

General Provider Information

NPI Number	:	1376872598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANANDA WELLNESS CENTERS, LLC

Provider Business Mailing Address
First Line	:	2727 BRYANT ST. STE. 500
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211
Country	:	US
Telephone Number	:	720-379-3519
Fax Number	:	720-524-3472

Provider Business Practice Location Address
First Line	:	2727 BRYANT ST STE 500
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-4153
Country	:	US
Telephone Number	:	720-379-3519
Fax Number	:	720-524-3472

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JARED C GRUHL
Credential	:	D.C.
Telephone Number	:	720-379-3519

Provider Enumeration Date	:	12/17/2009
Last Update Date	:	08/05/2010

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