Provider Demographics
NPI:1497802110
Name:COLORADO LIFE-CHANGING CARE
Entity Type:Organization
Organization Name:COLORADO LIFE-CHANGING CARE
Other - Org Name:HEALTHSOURCE OF LAKEWOOD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:TASHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-985-5540
Mailing Address - Street 1:12051 W ALAMEDA PKWY UNIT D-4
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2701
Mailing Address - Country:US
Mailing Address - Phone:303-985-5540
Mailing Address - Fax:303-985-5676
Practice Address - Street 1:12051 W ALAMEDA PKWY UNIT D-4
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2701
Practice Address - Country:US
Practice Address - Phone:303-985-5540
Practice Address - Fax:303-985-5676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR0004675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU77755Medicare UPIN
COC48683Medicare ID - Type Unspecified