Provider Demographics
NPI:1053633289
Name:COLORADO CHIROPRACTIC & MUSCLE CARE LLC
Entity Type:Organization
Organization Name:COLORADO CHIROPRACTIC & MUSCLE CARE LLC
Other - Org Name:COOR WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHRISTIANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-712-6059
Mailing Address - Street 1:2140 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2916
Mailing Address - Country:US
Mailing Address - Phone:970-712-6059
Mailing Address - Fax:970-797-4842
Practice Address - Street 1:2140 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2916
Practice Address - Country:US
Practice Address - Phone:970-712-6059
Practice Address - Fax:970-797-4842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB5046Medicare PIN