Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1730 | CO |
NPI | 1437668670 |
---|---|
Provider Name | Dr. Timothy Daniel Conwell |
First Address | Denver, CO 80211 |
Second Address | Denver, CO 80211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2017 |
Last Update Date | 20/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1407077100 | GROUP PRACTICE - IMAGING (01) | CO |