Provider Demographics
NPI:1073703005
Name:WATTENBARGER CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:WATTENBARGER CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDD
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WATTENBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-904-9994
Mailing Address - Street 1:9126 W BOWLES AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-8610
Mailing Address - Country:US
Mailing Address - Phone:303-904-9994
Mailing Address - Fax:303-904-9860
Practice Address - Street 1:9126 W BOWLES AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-8610
Practice Address - Country:US
Practice Address - Phone:303-904-9994
Practice Address - Fax:303-904-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5785261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC809049Medicare PIN