Provider Demographics
NPI:1326424169
Name:MONROE CHIROPRACTIC WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:MONROE CHIROPRACTIC WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-731-5566
Mailing Address - Street 1:46 EATON DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-8203
Mailing Address - Country:US
Mailing Address - Phone:970-731-5566
Mailing Address - Fax:970-731-5567
Practice Address - Street 1:46 EATON DR
Practice Address - Street 2:SUITE 1
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-8203
Practice Address - Country:US
Practice Address - Phone:970-731-5566
Practice Address - Fax:970-731-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty