Provider Demographics
NPI:1073864435
Name:CHIROPRACTIC TRUHEALTHDR
Entity Type:Organization
Organization Name:CHIROPRACTIC TRUHEALTHDR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOLISANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-233-5500
Mailing Address - Street 1:5102 N NEVADA AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8679
Mailing Address - Country:US
Mailing Address - Phone:719-599-8783
Mailing Address - Fax:
Practice Address - Street 1:5102 N NEVADA AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8679
Practice Address - Country:US
Practice Address - Phone:719-599-8783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6694111N00000X
CO6702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty