Provider Demographics
NPI:1235168527
Name:MISSION CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MISSION CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-425-6796
Mailing Address - Street 1:6425 WADSWORTH BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-4438
Mailing Address - Country:US
Mailing Address - Phone:303-425-6796
Mailing Address - Fax:303-425-0810
Practice Address - Street 1:6425 WADSWORTH BLVD
Practice Address - Street 2:STE 100
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-4438
Practice Address - Country:US
Practice Address - Phone:303-425-6796
Practice Address - Fax:303-425-0810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO800164Medicare PIN