Provider Demographics
NPI:1164774436
Name:KROESE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:KROESE CHIROPRACTIC PC
Other - Org Name:5280 CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:KROESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-835-9697
Mailing Address - Street 1:7352 E 7TH AVE UNIT 8
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6226
Mailing Address - Country:US
Mailing Address - Phone:972-835-9697
Mailing Address - Fax:
Practice Address - Street 1:535 16TH ST STE 200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-4261
Practice Address - Country:US
Practice Address - Phone:303-371-5280
Practice Address - Fax:303-623-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty