Provider Demographics
NPI:1568633030
Name:DAWSON CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:DAWSON CHIROPRACTIC CORPORATION
Other - Org Name:DAWSON CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROD
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-663-2200
Mailing Address - Street 1:1907 BOISE AVE. STE #1
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538
Mailing Address - Country:US
Mailing Address - Phone:970-663-2200
Mailing Address - Fax:970-663-2201
Practice Address - Street 1:1907 BOISE AVE STE. #1
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538
Practice Address - Country:US
Practice Address - Phone:970-663-2200
Practice Address - Fax:970-663-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6108111N00000X
CO6194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4061OtherMEDICARE PTAN
COB4061Medicare UPIN