Provider Demographics
NPI:1417255324
Name:BAHNEMANN FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:BAHNEMANN FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BAHNEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-258-8389
Mailing Address - Street 1:5421 HOPALONG TRL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-4603
Mailing Address - Country:US
Mailing Address - Phone:719-258-8389
Mailing Address - Fax:877-577-0339
Practice Address - Street 1:7610 N UNION BLVD STE 125
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-258-8389
Practice Address - Fax:877-577-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty