Provider Demographics
NPI:1609942879
Name:COE CHIROPRACTIC CLINIC PLLC
Entity Type:Organization
Organization Name:COE CHIROPRACTIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:M
Authorized Official - Last Name:COE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-874-7439
Mailing Address - Street 1:304 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-3612
Mailing Address - Country:US
Mailing Address - Phone:970-874-7439
Mailing Address - Fax:
Practice Address - Street 1:304 E 7TH ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-3612
Practice Address - Country:US
Practice Address - Phone:970-874-7439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC509518Medicare ID - Type Unspecified