Provider Demographics
NPI:1477915049
Name:LONGMONT JOINT AND SPINE, LLC
Entity Type:Organization
Organization Name:LONGMONT JOINT AND SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-835-7882
Mailing Address - Street 1:351 COFFMAN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5453
Mailing Address - Country:US
Mailing Address - Phone:303-835-7882
Mailing Address - Fax:303-835-7883
Practice Address - Street 1:351 COFFMAN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5453
Practice Address - Country:US
Practice Address - Phone:303-835-7882
Practice Address - Fax:303-835-7883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty