MEDICARE: DR. TIMOTHY DANIEL CONWELL DC

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	111NX0800X	Orthopedic Chiropractor	1730	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1407077100	OTHER	CO	GROUP PRACTICE - IMAGING

General Provider Information

NPI Number	:	1437668670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY DANIEL CONWELL DC

Provider Business Mailing Address
First Line	:	4444 UMATILLA ST.
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211
Country	:	US
Telephone Number	:	720-982-8088
Fax Number	:

Provider Business Practice Location Address
First Line	:	4444 UMATILLA ST.
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211
Country	:	US
Telephone Number	:	720-982-8088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2017
Last Update Date	:	07/21/2022

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