Provider Demographics
NPI:1487867073
Name:SOPRIS CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SOPRIS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:TESORO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-927-9204
Mailing Address - Street 1:711 E VALLEY RD
Mailing Address - Street 2:STE, 202A
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8370
Mailing Address - Country:US
Mailing Address - Phone:970-927-9204
Mailing Address - Fax:970-927-9238
Practice Address - Street 1:711 E VALLEY RD
Practice Address - Street 2:STE, 202A
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8370
Practice Address - Country:US
Practice Address - Phone:970-927-9204
Practice Address - Fax:970-927-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty