Provider Demographics
NPI:1508170168
Name:TEN MILE CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:TEN MILE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:JUNKERMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-453-8282
Mailing Address - Street 1:PO BOX 8802
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-9001
Mailing Address - Country:US
Mailing Address - Phone:970-453-8282
Mailing Address - Fax:970-453-0676
Practice Address - Street 1:424 SOUTH RIDGE STREET
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-8802
Practice Address - Country:US
Practice Address - Phone:970-453-8282
Practice Address - Fax:970-453-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4979305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4979OtherSTATE OF COLORADO LICENSE NUMBER