Provider Demographics
NPI:1477651305
Name:GROENE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:GROENE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-377-0055
Mailing Address - Street 1:1136 E. STUART ST
Mailing Address - Street 2:SUITE 4207
Mailing Address - City:FT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-377-0055
Mailing Address - Fax:970-377-3520
Practice Address - Street 1:1136 E. STUART ST
Practice Address - Street 2:SUITE 4207
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-377-0055
Practice Address - Fax:970-377-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO806312Medicare PIN
COU71867Medicare UPIN