Provider Demographics
NPI:1205028446
Name:CAFE OF LIFE, PC
Entity Type:Organization
Organization Name:CAFE OF LIFE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-444-7744
Mailing Address - Street 1:2835 PEARL ST
Mailing Address - Street 2:UNIT D
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1140
Mailing Address - Country:US
Mailing Address - Phone:303-444-7744
Mailing Address - Fax:
Practice Address - Street 1:2835 PEARL ST
Practice Address - Street 2:UNIT D
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1140
Practice Address - Country:US
Practice Address - Phone:303-444-7744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty