Provider Demographics
NPI:1609102250
Name:DISCOVER CHIROPRACTIC PC
Entity Type:Organization
Organization Name:DISCOVER CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TCA
Authorized Official - Prefix:MS
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-425-9557
Mailing Address - Street 1:7535 W 92ND AVE
Mailing Address - Street 2:#600
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-5612
Mailing Address - Country:US
Mailing Address - Phone:303-425-9557
Mailing Address - Fax:303-425-3399
Practice Address - Street 1:7535 W 92ND AVE
Practice Address - Street 2:#600
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-5612
Practice Address - Country:US
Practice Address - Phone:303-425-9557
Practice Address - Fax:303-425-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4710111N00000X
CO5883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC48313Medicare UPIN
COC807151Medicare UPIN