Provider Demographics
NPI:1235504168
Name:MAXIMIZE LIFE CHIROPRACTIC
Entity Type:Organization
Organization Name:MAXIMIZE LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROCAFORT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-922-8146
Mailing Address - Street 1:945 S FEDERAL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-3586
Mailing Address - Country:US
Mailing Address - Phone:303-922-8146
Mailing Address - Fax:
Practice Address - Street 1:945 S FEDERAL BLVD STE B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-3586
Practice Address - Country:US
Practice Address - Phone:303-922-8146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006936111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO347932Medicare PIN