MEDICARE: ULTIMATE EXPRESSION 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	5953	CO

General Provider Information

NPI Number	:	1801039862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTIMATE EXPRESSION LLC

Provider Business Mailing Address
First Line	:	1101 OAKRIDGE DR
Second Line	:	SUITE A
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5528
Country	:	US
Telephone Number	:	970-226-1117
Fax Number	:	970-226-0251

Provider Business Practice Location Address
First Line	:	1101 OAKRIDGE DR
Second Line	:	SUITE A
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5528
Country	:	US
Telephone Number	:	970-226-1117
Fax Number	:	970-226-0251

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL FARRELL
Credential	:	D.C.
Telephone Number	:	970-226-1117

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	04/07/2009

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Directions to “ULTIMATE EXPRESSION LLC ” Practice Location

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