Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2946 | CO |
NPI | 1144331919 |
---|---|
Provider Name | Dr. David Keith Powell |
First Address | Woodland Park, CO 80866-5176 |
Second Address | Woodland Park, CO 80863-2429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 17/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U40025 | (02) | CO |