MEDICARE: INTEGRATED CHIROPRACTIC 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	CHR.0006778	CO

General Provider Information

NPI Number	:	1982180188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	931 MOUNTAIN AVE
Second Line	:
City	:	BERTHOUD
State	:	CO
Zip	:	80513-1321
Country	:	US
Telephone Number	:	970-744-6788
Fax Number	:

Provider Business Practice Location Address
First Line	:	931 MOUNTAIN AVE
Second Line	:
City	:	BERTHOUD
State	:	CO
Zip	:	80513-1321
Country	:	US
Telephone Number	:	970-744-6788
Fax Number	:

Authorized Official
Title or Position	:	PART-OWNER/CHIROPRACTOR
Name	:	JEFFREY BJORKLUND
Credential	:
Telephone Number	:	970-744-6788

Provider Enumeration Date	:	07/11/2018
Last Update Date	:	07/11/2018

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