Provider Demographics
NPI:1518311646
Name:ONE HUNDRED PERCENT CHIROPRACTIC FORT COLLINS ONE LLC
Entity Type:Organization
Organization Name:ONE HUNDRED PERCENT CHIROPRACTIC FORT COLLINS ONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:MAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-503-7525
Mailing Address - Street 1:4532 MCMURRY AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-8022
Mailing Address - Country:US
Mailing Address - Phone:970-294-4150
Mailing Address - Fax:970-286-2913
Practice Address - Street 1:4532 MCMURRY AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-8022
Practice Address - Country:US
Practice Address - Phone:970-294-4150
Practice Address - Fax:970-286-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007427261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center