Provider Demographics
NPI:1336472950
Name:NEW LEAF CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:NEW LEAF CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:NAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-776-6767
Mailing Address - Street 1:600 S AIRPORT RD
Mailing Address - Street 2:BLDNG C UNIT C
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6424
Mailing Address - Country:US
Mailing Address - Phone:303-776-6767
Mailing Address - Fax:303-776-4748
Practice Address - Street 1:600 S AIRPORT RD
Practice Address - Street 2:BLDNG C UNIT C
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-6424
Practice Address - Country:US
Practice Address - Phone:303-776-6767
Practice Address - Fax:303-776-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6258111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty