Provider Demographics
NPI:1366505836
Name:BOVADILLA CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:BOVADILLA CHIROPRACTIC CLINIC INC
Other - Org Name:BOVADILLA CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-850-6000
Mailing Address - Street 1:4045 WADSWORTH BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4626
Mailing Address - Country:US
Mailing Address - Phone:303-647-8131
Mailing Address - Fax:918-493-1773
Practice Address - Street 1:4045 WADSWORTH BLVD STE 307
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4626
Practice Address - Country:US
Practice Address - Phone:303-647-8131
Practice Address - Fax:918-770-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1417975897OtherNPI OF DOCTOR