Provider Demographics
NPI:1063684777
Name:TRANSFORMATION CHIROPRACTIC
Entity Type:Organization
Organization Name:TRANSFORMATION CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-741-0990
Mailing Address - Street 1:6854 S DALLAS WAY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3621
Mailing Address - Country:US
Mailing Address - Phone:303-741-0990
Mailing Address - Fax:303-741-0991
Practice Address - Street 1:6854 S DALLAS WAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80112-3621
Practice Address - Country:US
Practice Address - Phone:303-741-0990
Practice Address - Fax:303-741-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0005073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC450058Medicare PIN