Provider Demographics
NPI:1598997082
Name:WALL TO WALL HEALTH PC
Entity Type:Organization
Organization Name:WALL TO WALL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-940-7167
Mailing Address - Street 1:4275 HARLAN ST.
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5159
Mailing Address - Country:US
Mailing Address - Phone:303-940-7167
Mailing Address - Fax:303-640-7258
Practice Address - Street 1:4275 HARLAN ST.
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5159
Practice Address - Country:US
Practice Address - Phone:303-940-7167
Practice Address - Fax:303-640-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty