Provider Demographics
NPI:1093046740
Name:BREITENBACH CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BREITENBACH CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BREITENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-882-2275
Mailing Address - Street 1:PO BOX 805
Mailing Address - Street 2:
Mailing Address - City:DOLORES
Mailing Address - State:CO
Mailing Address - Zip Code:81323-0805
Mailing Address - Country:US
Mailing Address - Phone:970-882-2275
Mailing Address - Fax:970-882-1238
Practice Address - Street 1:18483 HIGHWAY 145
Practice Address - Street 2:
Practice Address - City:DOLORES
Practice Address - State:CO
Practice Address - Zip Code:81323-0805
Practice Address - Country:US
Practice Address - Phone:970-882-2275
Practice Address - Fax:970-882-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4902111N00000X
CO1184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty