Provider Demographics
NPI:1164604872
Name:ESSENTIAL CHIROPRACTIC
Entity Type:Organization
Organization Name:ESSENTIAL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:H
Authorized Official - Middle Name:M
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-730-7445
Mailing Address - Street 1:151 W MINERAL AVE
Mailing Address - Street 2:#105
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5611
Mailing Address - Country:US
Mailing Address - Phone:303-730-7445
Mailing Address - Fax:
Practice Address - Street 1:151 W MINERAL AVE
Practice Address - Street 2:#105
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5611
Practice Address - Country:US
Practice Address - Phone:303-730-7445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3900111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC491758Medicare PIN