Provider Demographics
NPI:1376738146
Name:FISHER'S PEAK CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:FISHER'S PEAK CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PC
Authorized Official - Phone:719-846-4990
Mailing Address - Street 1:165 E FIRST ST
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-3001
Mailing Address - Country:US
Mailing Address - Phone:719-846-4990
Mailing Address - Fax:719-846-3505
Practice Address - Street 1:165 E FIRST ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-3001
Practice Address - Country:US
Practice Address - Phone:719-846-4990
Practice Address - Fax:719-846-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1C17893Medicare PIN