Provider Demographics
NPI:1659668259
Name:MOUNTAIN RANGE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MOUNTAIN RANGE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WRABETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-216-4948
Mailing Address - Street 1:2800 ELAINE DR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5476
Mailing Address - Country:US
Mailing Address - Phone:651-216-4948
Mailing Address - Fax:
Practice Address - Street 1:2800 ELAINE DR
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-5476
Practice Address - Country:US
Practice Address - Phone:651-216-4948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty