MEDICARE: ELENA RENEE NORTHEN 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	111N00000X	Chiropractor	0007778	CO

General Provider Information

NPI Number	:	1558853952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA RENEE NORTHEN DC

Provider Business Mailing Address
First Line	:	1940 E 18TH AVE STE B
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-1108
Country	:	US
Telephone Number	:	720-398-2050
Fax Number	:

Provider Business Practice Location Address
First Line	:	1940 E 18TH AVE STE B
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-1108
Country	:	US
Telephone Number	:	720-398-2050
Fax Number	:

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

Provider Enumeration Date	:	05/31/2018
Last Update Date	:	02/28/2020

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Directions to “ ELENA RENEE NORTHEN DC” Practice Location

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