MEDICARE: MARK A TESTA 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	3893	CO

General Provider Information

NPI Number	:	1881633246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A TESTA DC

Provider Business Mailing Address
First Line	:	4291 LOWELL BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211
Country	:	US
Telephone Number	:	303-455-2386
Fax Number	:	877-834-4170

Provider Business Practice Location Address
First Line	:	4291 LOWELL BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211
Country	:	US
Telephone Number	:	303-455-2386
Fax Number	:	877-834-4170

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/08/2007

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