Provider Demographics
NPI:1164726303
Name:REJUV HEALTH MAKEOVERS
Entity Type:Organization
Organization Name:REJUV HEALTH MAKEOVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:
Authorized Official - Last Name:MAULDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-331-5756
Mailing Address - Street 1:1120 CHESTNUT DRIVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-7636
Mailing Address - Country:US
Mailing Address - Phone:720-331-5756
Mailing Address - Fax:
Practice Address - Street 1:742 TENACITY, UNIT A
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504
Practice Address - Country:US
Practice Address - Phone:720-331-5756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty