Provider Demographics
NPI:1144401357
Name:PELTZMAN CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:PELTZMAN CHIROPRACTIC, PC
Other - Org Name:GLENWOOD CHIROPRACTIC PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MITCHEL
Authorized Official - Last Name:PELTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-945-8466
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0008
Mailing Address - Country:US
Mailing Address - Phone:970-945-8466
Mailing Address - Fax:970-945-8413
Practice Address - Street 1:1517 BLAKE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3643
Practice Address - Country:US
Practice Address - Phone:970-945-8466
Practice Address - Fax:970-945-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3184111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO454198Medicare PIN
CO454208Medicare PIN