Provider Demographics
NPI:1245429570
Name:DECKER FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DECKER FAMILY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-499-5000
Mailing Address - Street 1:4150 DARLEY AVE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6557
Mailing Address - Country:US
Mailing Address - Phone:303-499-5000
Mailing Address - Fax:303-499-4962
Practice Address - Street 1:4150 DARLEY AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6557
Practice Address - Country:US
Practice Address - Phone:303-499-5000
Practice Address - Fax:303-499-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO451948Medicare PIN