Provider Demographics
NPI:1306037544
Name:DAZAL, PC
Entity Type:Organization
Organization Name:DAZAL, PC
Other - Org Name:100 PERCENT A CHIROPRACTIC WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:PRICE KLOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-667-1007
Mailing Address - Street 1:213 E CACHE LA POUDRE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2958
Mailing Address - Country:US
Mailing Address - Phone:719-667-1007
Mailing Address - Fax:719-630-7683
Practice Address - Street 1:213 E CACHE LA POUDRE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2958
Practice Address - Country:US
Practice Address - Phone:719-667-1007
Practice Address - Fax:719-630-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC800430Medicare PIN
COV02619Medicare UPIN