Provider Demographics
NPI:1417407925
Name:PARKER PAIN RELIEF CLINIC
Entity Type:Organization
Organization Name:PARKER PAIN RELIEF CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PAOLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:D,C,
Authorized Official - Phone:720-851-0600
Mailing Address - Street 1:18901 E MAINSTREET
Mailing Address - Street 2:STE C
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3474
Mailing Address - Country:US
Mailing Address - Phone:720-851-0600
Mailing Address - Fax:720-851-0508
Practice Address - Street 1:18901 E MAINSTREET
Practice Address - Street 2:STE C
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3474
Practice Address - Country:US
Practice Address - Phone:720-851-0600
Practice Address - Fax:720-851-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR0004652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1497198725Medicare NSC