Provider Demographics
NPI:1659502847
Name:ALPHA OMEGA CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:ALPHA OMEGA CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRITSCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-404-0950
Mailing Address - Street 1:6343 W 120TH AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3711
Mailing Address - Country:US
Mailing Address - Phone:303-404-0950
Mailing Address - Fax:303-404-0948
Practice Address - Street 1:6343 W 120TH AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-3711
Practice Address - Country:US
Practice Address - Phone:303-404-0950
Practice Address - Fax:303-404-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-6281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4695Medicare PIN