Provider Demographics
NPI:1427382662
Name:SHIFT POWERED BY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SHIFT POWERED BY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:VESPA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-433-0933
Mailing Address - Street 1:2501 15TH ST UNIT 1C
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3986
Mailing Address - Country:US
Mailing Address - Phone:303-433-0933
Mailing Address - Fax:303-433-1679
Practice Address - Street 1:2501 15TH ST UNIT 1C
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3986
Practice Address - Country:US
Practice Address - Phone:303-433-0933
Practice Address - Fax:303-433-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty