MEDICARE: FRONT RANGE DMX

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	247100000X	Radiologic Technologist	5016	CO

General Provider Information

NPI Number	:	1992001622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONT RANGE DMX

Provider Business Mailing Address
First Line	:	954 NORTH ST
Second Line	:	SECOND FLOOR
City	:	BOULDER
State	:	CO
Zip	:	80304-3419
Country	:	US
Telephone Number	:	303-938-9070
Fax Number	:	303-938-9170

Provider Business Practice Location Address
First Line	:	954 NORTH ST
Second Line	:	SECOND FLOOR
City	:	BOULDER
State	:	CO
Zip	:	80304-3419
Country	:	US
Telephone Number	:	303-938-9070
Fax Number	:	303-938-9170

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EVAN KATZ
Credential	:	DC
Telephone Number	:	303-938-9070

Provider Enumeration Date	:	01/27/2011
Last Update Date	:	08/04/2011

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Directions to “FRONT RANGE DMX ” Practice Location

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