Provider Demographics
NPI:1396840716
Name:GRAND JUNCTION CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:GRAND JUNCTION CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-241-1199
Mailing Address - Street 1:1910 N 12TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2912
Mailing Address - Country:US
Mailing Address - Phone:970-241-1199
Mailing Address - Fax:970-241-2047
Practice Address - Street 1:1910 N 12TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2912
Practice Address - Country:US
Practice Address - Phone:970-241-1199
Practice Address - Fax:970-241-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCM0003Medicare PIN