Provider Demographics
NPI:1114257177
Name:THRIVE CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:THRIVE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAPPER
Authorized Official - Middle Name:O
Authorized Official - Last Name:NICCUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-259-0968
Mailing Address - Street 1:202 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4618
Mailing Address - Country:US
Mailing Address - Phone:970-259-0968
Mailing Address - Fax:970-259-3679
Practice Address - Street 1:202 W 22ND ST
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4618
Practice Address - Country:US
Practice Address - Phone:970-259-0968
Practice Address - Fax:970-259-3679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5103302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization