MEDICARE: MR. ERRIK ENEWOLD 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	6105	CO

General Provider Information

NPI Number	:	1760651293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERRIK ENEWOLD D.C.

Provider Business Mailing Address
First Line	:	118 W 6TH ST
Second Line	:	SUITE 20
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-2964
Country	:	US
Telephone Number	:	970-945-5964
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 W 6TH ST
Second Line	:	SUITE 20
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-2964
Country	:	US
Telephone Number	:	970-945-5964
Fax Number	:

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

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	05/22/2012

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