MEDICARE: SOUL SOURCE CHIROPRACTIC 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

General Provider Information

NPI Number	:	1528995438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL SOURCE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	7355 W 88TH AVE UNIT R
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-6481
Country	:	US
Telephone Number	:	720-210-4723
Fax Number	:

Provider Business Practice Location Address
First Line	:	7355 W 88TH AVE UNIT R
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-6481
Country	:	US
Telephone Number	:	720-210-4723
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRYCE HILL
Credential	:	DC
Telephone Number	:	720-210-4723

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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