Provider Demographics
NPI:1568713865
Name:DENVER TECH CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:DENVER TECH CHIROPRACTIC CENTER PC
Other - Org Name:NIKITOW CHIROPRACTIC WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:NIKITOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-773-8027
Mailing Address - Street 1:99 INVERNESS DR E
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5118
Mailing Address - Country:US
Mailing Address - Phone:303-773-8027
Mailing Address - Fax:303-694-3071
Practice Address - Street 1:99 INVERNESS DR E
Practice Address - Street 2:SUITE 120
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5118
Practice Address - Country:US
Practice Address - Phone:303-773-8027
Practice Address - Fax:303-694-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC11673Medicare UPIN