Provider Demographics
NPI:1457656274
Name:BOCKELMANN CHIROPRACTIC
Entity Type:Organization
Organization Name:BOCKELMANN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BOCKELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-577-9000
Mailing Address - Street 1:521 S SAINT VRAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-7416
Mailing Address - Country:US
Mailing Address - Phone:970-577-9000
Mailing Address - Fax:
Practice Address - Street 1:521 S SAINT VRAIN AVE
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-7416
Practice Address - Country:US
Practice Address - Phone:970-577-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU6489Medicare UPIN