Provider Demographics
NPI:1467988840
Name:PAFFENROTH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PAFFENROTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SKYLAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PAFFENROTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-850-0684
Mailing Address - Street 1:2526 SUNSET DR
Mailing Address - Street 2:APT 188
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2526 SUNSET DR
Practice Address - Street 2:188
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-9705
Practice Address - Country:US
Practice Address - Phone:920-850-0684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty