Provider Demographics
NPI:1629267257
Name:COMMUNITY BACK & NECK CENTER, P.C.
Entity Type:Organization
Organization Name:COMMUNITY BACK & NECK CENTER, P.C.
Other - Org Name:CORONADO CHIROPRACTIC, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:REINHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-263-0633
Mailing Address - Street 1:569 32 RD
Mailing Address - Street 2:SUITE 5C
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-7053
Mailing Address - Country:US
Mailing Address - Phone:970-263-0633
Mailing Address - Fax:970-263-4047
Practice Address - Street 1:569 32 RD
Practice Address - Street 2:SUITE 5C
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-7053
Practice Address - Country:US
Practice Address - Phone:970-263-0633
Practice Address - Fax:970-263-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC801323Medicare UPIN