MEDICARE: DR. MARYBETH GUEVARA 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	4938	CO

General Provider Information

NPI Number	:	1881698462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYBETH GUEVARA DC

Provider Business Mailing Address
First Line	:	3152 BLUE MOUNTAIN WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4503
Country	:	US
Telephone Number	:	719-684-7832
Fax Number	:

Provider Business Practice Location Address
First Line	:	3152 BLUE MOUNTAIN WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4503
Country	:	US
Telephone Number	:	719-684-7832
Fax Number	:

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	12/17/2010

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