Provider Demographics
NPI:1629277314
Name:HEUSER CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:HEUSER CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HERMAN
Authorized Official - Last Name:HEUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-574-6006
Mailing Address - Street 1:245 S ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-2713
Mailing Address - Country:US
Mailing Address - Phone:719-574-6006
Mailing Address - Fax:719-574-7365
Practice Address - Street 1:245 S ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-2713
Practice Address - Country:US
Practice Address - Phone:719-574-6006
Practice Address - Fax:719-574-7365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCM0903Medicare UPIN