Provider Demographics
NPI:1659424000
Name:CHRISTOPHER VILLAGE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:CHRISTOPHER VILLAGE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-666-7717
Mailing Address - Street 1:1017 E SOUTH BOULDER RD STE A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2547
Mailing Address - Country:US
Mailing Address - Phone:303-666-7717
Mailing Address - Fax:303-666-7746
Practice Address - Street 1:1017 E SOUTH BOULDER RD STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2547
Practice Address - Country:US
Practice Address - Phone:303-666-7717
Practice Address - Fax:303-666-7746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1797-3OtherBLUECROSS BLUESHIELD
COM12057OtherWORKERS COMP
CO1797-3OtherBLUECROSS BLUESHIELD