Provider Demographics
NPI:1427202449
Name:WHEATRIDGE CHIROPRACTIC AND ACUPUNCTURE, PC
Entity Type:Organization
Organization Name:WHEATRIDGE CHIROPRACTIC AND ACUPUNCTURE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-422-6301
Mailing Address - Street 1:4350 WADSWORTH BLVD
Mailing Address - Street 2:430
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4641
Mailing Address - Country:US
Mailing Address - Phone:303-422-6301
Mailing Address - Fax:303-431-0400
Practice Address - Street 1:4350 WADSWORTH BLVD
Practice Address - Street 2:430
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4641
Practice Address - Country:US
Practice Address - Phone:303-422-6301
Practice Address - Fax:303-431-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1339111N00000X
CO518171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty