Provider Demographics
NPI:1346602216
Name:COMPREHENSIVE CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:COMPREHENSIVE CHIROPRACTIC P.C.
Other - Org Name:COMPREHENSIVE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-538-7581
Mailing Address - Street 1:1890 S WADSWORTH BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-6804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1890 S WADSWORTH BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-6804
Practice Address - Country:US
Practice Address - Phone:352-538-7581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation