Provider Demographics
NPI:1114225018
Name:SCREEN CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:SCREEN CHIROPRACTIC INC.
Other - Org Name:COLORADO CHIROPRACTIC CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SCREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-632-3662
Mailing Address - Street 1:991 E MONTE VISTA AVE
Mailing Address - Street 2:#2
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-0636
Mailing Address - Country:US
Mailing Address - Phone:209-632-3662
Mailing Address - Fax:209-633-2629
Practice Address - Street 1:991 E MONTE VISTA AVE
Practice Address - Street 2:#2
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-0636
Practice Address - Country:US
Practice Address - Phone:209-632-3662
Practice Address - Fax:209-633-2629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty