Provider Demographics
NPI:1417212960
Name:IMPACT CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:IMPACT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-223-5501
Mailing Address - Street 1:1027 W HORSETOOTH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5981
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1027 W HORSETOOTH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5981
Practice Address - Country:US
Practice Address - Phone:970-223-5501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty