Provider Demographics
NPI:1629454012
Name:DURANGO SPINE & SPORT LLC
Entity Type:Organization
Organization Name:DURANGO SPINE & SPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KOURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-422-8544
Mailing Address - Street 1:270 E COLLEGE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5599
Mailing Address - Country:US
Mailing Address - Phone:970-422-8544
Mailing Address - Fax:970-422-7091
Practice Address - Street 1:270 E COLLEGE DR
Practice Address - Street 2:STE 100
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5599
Practice Address - Country:US
Practice Address - Phone:970-422-8544
Practice Address - Fax:970-422-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0006555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty