Provider Demographics
NPI:1619050192
Name:STJERNHOLM BROTHERS FAMILY CHIROPRATIC
Entity Type:Organization
Organization Name:STJERNHOLM BROTHERS FAMILY CHIROPRATIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:STJERNHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-468-9555
Mailing Address - Street 1:PO BOX 1910
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498-1910
Mailing Address - Country:US
Mailing Address - Phone:970-468-9555
Mailing Address - Fax:970-468-0948
Practice Address - Street 1:1000 NORTH SUMMIT BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-376-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3244 AND 3306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COK1003Medicare ID - Type UnspecifiedCLINIC ID NUMBER