Provider Demographics
NPI:1114316957
Name:LIFESPAN FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:LIFESPAN FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:DARLING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-223-3335
Mailing Address - Street 1:132 W TROUTMAN PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5967
Mailing Address - Country:US
Mailing Address - Phone:970-223-3335
Mailing Address - Fax:
Practice Address - Street 1:132 W TROUTMAN PKWY
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5967
Practice Address - Country:US
Practice Address - Phone:970-223-3335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0005005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty