Provider Demographics
NPI:1528001732
Name:THE CHIROPRACTIC WELLNESS CENTER
Entity Type:Organization
Organization Name:THE CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-864-7480
Mailing Address - Street 1:316 HIGHWAY 6 AND 50
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-2642
Mailing Address - Country:US
Mailing Address - Phone:970-858-0544
Mailing Address - Fax:970-858-7749
Practice Address - Street 1:853 MAIN ST
Practice Address - Street 2:
Practice Address - City:NUCLA
Practice Address - State:CO
Practice Address - Zip Code:81424
Practice Address - Country:US
Practice Address - Phone:970-864-7480
Practice Address - Fax:970-858-7749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC514028Medicare ID - Type Unspecified