Provider Demographics
NPI:1346529294
Name:ROOTS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ROOTS CHIROPRACTIC LLC
Other - Org Name:DISCOVER HEALTH AND WELLNESS CENTER DTC PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-489-8000
Mailing Address - Street 1:8000 E PRENTICE AVE
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2725
Mailing Address - Country:US
Mailing Address - Phone:720-489-8000
Mailing Address - Fax:720-489-8001
Practice Address - Street 1:8000 E PRENTICE AVE
Practice Address - Street 2:SUITE A-2
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2725
Practice Address - Country:US
Practice Address - Phone:720-489-8000
Practice Address - Fax:720-489-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4710111N00000X
CO111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty