Provider Demographics
NPI:1144331919
Name:POWELL, DAVID KEITH (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KEITH
Last Name:POWELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5176
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-5176
Mailing Address - Country:US
Mailing Address - Phone:719-687-6096
Mailing Address - Fax:719-687-9623
Practice Address - Street 1:490 RAMPART RANGE RD
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-2429
Practice Address - Country:US
Practice Address - Phone:719-687-6096
Practice Address - Fax:719-687-9623
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2946111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26973Medicare ID - Type UnspecifiedBCBS MEDICARE
COU40025Medicare UPIN