Provider Demographics
NPI:1326395765
Name:ALTERNATIVE HEALTH CLINIC, PC
Entity Type:Organization
Organization Name:ALTERNATIVE HEALTH CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-449-2225
Mailing Address - Street 1:5761 N ORCHARD CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5815
Mailing Address - Country:US
Mailing Address - Phone:303-449-2225
Mailing Address - Fax:303-527-2969
Practice Address - Street 1:5761 N ORCHARD CREEK CIR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5815
Practice Address - Country:US
Practice Address - Phone:303-449-2225
Practice Address - Fax:303-527-2969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1720106503OtherMEDICARENPI