MEDICARE: DR. JASON J GRUNDHAUSER D.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	5593	CO

General Provider Information

NPI Number	:	1457445561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON J GRUNDHAUSER D.C.

Provider Business Mailing Address
First Line	:	4740 FLINTRIDGE DR STE 101
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4254
Country	:	US
Telephone Number	:	719-594-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	4740 FLINTRIDGE DR STE 101
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4254
Country	:	US
Telephone Number	:	719-594-0071
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/03/2009

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