Provider Demographics
NPI:1164027967
Name:PEAK FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PEAK FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOCTOR, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-475-8877
Mailing Address - Street 1:1935 E BIJOU ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5816
Mailing Address - Country:US
Mailing Address - Phone:719-475-8877
Mailing Address - Fax:719-578-0071
Practice Address - Street 1:1935 E BIJOU ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5816
Practice Address - Country:US
Practice Address - Phone:719-475-8877
Practice Address - Fax:719-578-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty