Provider Demographics
NPI:1043635790
Name:HOLY CROSS CHIROPRACTIC
Entity Type:Organization
Organization Name:HOLY CROSS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ROCKWELL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-688-5842
Mailing Address - Street 1:PO BOX 1131
Mailing Address - Street 2:
Mailing Address - City:MINTURN
Mailing Address - State:CO
Mailing Address - Zip Code:81645-1131
Mailing Address - Country:US
Mailing Address - Phone:970-688-5842
Mailing Address - Fax:
Practice Address - Street 1:376 PINE STREET
Practice Address - Street 2:
Practice Address - City:MINTURN
Practice Address - State:CO
Practice Address - Zip Code:81645
Practice Address - Country:US
Practice Address - Phone:970-688-5842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5798111NR0200X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty