Provider Demographics
NPI:1326413535
Name:SOUTH POINTE CHIROPRACTIC
Entity Type:Organization
Organization Name:SOUTH POINTE CHIROPRACTIC
Other - Org Name:SOUTH POINTE PHYSICAL REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-665-8444
Mailing Address - Street 1:380 EMPIRE RD
Mailing Address - Street 2:STE 120
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2677
Mailing Address - Country:US
Mailing Address - Phone:303-665-8444
Mailing Address - Fax:303-665-8448
Practice Address - Street 1:380 EMPIRE RD
Practice Address - Street 2:STE 120
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2677
Practice Address - Country:US
Practice Address - Phone:303-665-8444
Practice Address - Fax:303-665-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty