Provider Demographics
NPI:1316370463
Name:FRUITA CHIROPRACTIC AND MASSAGE
Entity Type:Organization
Organization Name:FRUITA CHIROPRACTIC AND MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BLAHA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-639-9730
Mailing Address - Street 1:122 E ASPEN AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-2542
Mailing Address - Country:US
Mailing Address - Phone:970-639-9730
Mailing Address - Fax:970-639-9730
Practice Address - Street 1:122 E ASPEN AVE
Practice Address - Street 2:UNIT A
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2542
Practice Address - Country:US
Practice Address - Phone:970-639-9730
Practice Address - Fax:970-639-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0006988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty