Provider Demographics
NPI:1316013741
Name:APPLIED CHIROPRACTIC HEALTH CENTER PC
Entity Type:Organization
Organization Name:APPLIED CHIROPRACTIC HEALTH CENTER PC
Other - Org Name:APPLIED CHIROPRACTIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-242-0808
Mailing Address - Street 1:2472 PATTERSON RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1285
Mailing Address - Country:US
Mailing Address - Phone:970-242-0808
Mailing Address - Fax:970-243-5750
Practice Address - Street 1:2472 PATTERSON RD
Practice Address - Street 2:SUITE 7
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1285
Practice Address - Country:US
Practice Address - Phone:970-242-0808
Practice Address - Fax:970-243-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COM10438OtherWC
CO75681871Medicaid
COC504128Medicare PIN
COM10438OtherWC