MEDICARE: JEFFREY BRYAN PRYSTUPA 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	111NT0100X	Thermography Chiropractor	2293	CO

General Provider Information

NPI Number	:	1457893695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY BRYAN PRYSTUPA D.C

Provider Business Mailing Address
First Line	:	8155 W 94TH AVE
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80021-4515
Country	:	US
Telephone Number	:	303-423-4610
Fax Number	:

Provider Business Practice Location Address
First Line	:	8155 W 94TH AVE
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80021-4515
Country	:	US
Telephone Number	:	303-423-4610
Fax Number	:

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

Provider Enumeration Date	:	11/04/2016
Last Update Date	:	11/04/2016

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