Provider Demographics
NPI:1639537509
Name:NONFORCE CHIROPRACTIC FUNCTIONAL MEDICINE
Entity Type:Organization
Organization Name:NONFORCE CHIROPRACTIC FUNCTIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEKTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-233-1293
Mailing Address - Street 1:1621 SALVIA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2781
Mailing Address - Country:US
Mailing Address - Phone:720-234-7489
Mailing Address - Fax:
Practice Address - Street 1:607 10TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5817
Practice Address - Country:US
Practice Address - Phone:303-233-1293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty