Provider Demographics
NPI:1548789704
Name:LIFTED CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LIFTED CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LONDEE
Authorized Official - Middle Name:LAREE
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-340-0153
Mailing Address - Street 1:PO BOX 880203
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80488-0203
Mailing Address - Country:US
Mailing Address - Phone:970-367-7187
Mailing Address - Fax:
Practice Address - Street 1:2700 LINCOLN AVE
Practice Address - Street 2:#880203
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-367-7187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty