Provider Demographics
NPI:1568836641
Name:YAMPA VALLEY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:YAMPA VALLEY CHIROPRACTIC CENTER
Other - Org Name:DOUGLAS KENYON, DC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:KENYON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-846-3265
Mailing Address - Street 1:PO BOX 771773
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80477-1773
Mailing Address - Country:US
Mailing Address - Phone:970-846-3265
Mailing Address - Fax:
Practice Address - Street 1:2851 RIVERSIDE PLZ UNIT 210A
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-5224
Practice Address - Country:US
Practice Address - Phone:970-846-3265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty