Provider Demographics
NPI:1003117177
Name:ASSOCIATED BACK CLINIC
Entity Type:Organization
Organization Name:ASSOCIATED BACK CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WARING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-363-9095
Mailing Address - Street 1:11275 E MISSISSIPPI AVE STE 1E8
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2818
Mailing Address - Country:US
Mailing Address - Phone:303-363-9095
Mailing Address - Fax:303-363-6794
Practice Address - Street 1:11275 E MISSISSIPPI AVE STE 1E8
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2818
Practice Address - Country:US
Practice Address - Phone:303-363-9095
Practice Address - Fax:303-363-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1295827194OtherNPI
CO1295827194OtherNPI