Provider Demographics
NPI:1225067929
Name:PROLIFIC CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:PROLIFIC CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROECHELLE
Authorized Official - Middle Name:LAVETTE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-337-1321
Mailing Address - Street 1:2323 S TROY ST
Mailing Address - Street 2:SUITE 2-105
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1946
Mailing Address - Country:US
Mailing Address - Phone:303-337-1321
Mailing Address - Fax:303-337-2305
Practice Address - Street 1:2323 S TROY ST
Practice Address - Street 2:SUITE 2-105
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1946
Practice Address - Country:US
Practice Address - Phone:303-337-1321
Practice Address - Fax:303-337-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COTR658937OtherBLUE CROSS BLUE SHIELD
COTR658937OtherBLUE CROSS BLUE SHIELD
COC45013Medicare ID - Type Unspecified