# BROADWAY SOUTH CHIROPRACTIC CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407197742
- **Authorized official:** DR. BRAIN K WILSON DC (OWNER)
- **Authorized official phone:** (303) 761-8521

## Contact information

- **Practice address:** 3601 S BROADWAY, ENGLEWOOD, CO 80113-3610
- **Practice address phone:** (303) 761-8521
- **Mailing address:** 3601 S BROADWAY, ENGLEWOOD, CO 80113-3610
- **Mailing address phone:** (303) 761-8521

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NI0900X | Internist Chiropractor | 968 | CO | Yes |

## Other

- **Enumeration date:** 03/12/2013
- **Last updated:** 03/12/2013