MEDICARE: THRIVAL MODE 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	:	1760981054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVAL MODE LLC

Provider Business Mailing Address
First Line	:	PO BOX 770691
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80477-0691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 CENTRAL PARK DR UNIT 101A
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8885
Country	:	US
Telephone Number	:	970-717-0012
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEVIN GOWER
Credential	:	DC
Telephone Number	:	970-717-0012

Provider Enumeration Date	:	02/02/2018
Last Update Date	:	05/10/2020

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