Provider Demographics
NPI:1407307523
Name:CORE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CORE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAILE
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MYRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-217-7453
Mailing Address - Street 1:4730 CENTENNIAL BLVD
Mailing Address - Street 2:102
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3338
Mailing Address - Country:US
Mailing Address - Phone:719-217-7453
Mailing Address - Fax:
Practice Address - Street 1:4730 CENTENNIAL BLVD
Practice Address - Street 2:102
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3338
Practice Address - Country:US
Practice Address - Phone:719-258-8349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007486261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center