MEDICARE: DR. OMID FERDOWSIAN D.C., C.C.E.P.

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	5466	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	668207	OTHER	CO	BC/BS PROVIDER #

General Provider Information

NPI Number	:	1861452625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMID FERDOWSIAN D.C., C.C.E.P.

Provider Business Mailing Address
First Line	:	899 LOGAN ST
Second Line	:	SUITE 105
City	:	DENVER
State	:	CO
Zip	:	80203-3130
Country	:	US
Telephone Number	:	303-831-1122
Fax Number	:	303-831-1144

Provider Business Practice Location Address
First Line	:	899 N LOGAN ST
Second Line	:	STE 105
City	:	DENVER
State	:	CO
Zip	:	80203-3154
Country	:	US
Telephone Number	:	303-831-1122
Fax Number	:	303-831-1144

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	02/14/2022

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