Provider Demographics
NPI:1669487351
Name:TRINITY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:TRINITY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DAX
Authorized Official - Last Name:RUPP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-425-9557
Mailing Address - Street 1:8410 WADSWORTH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-0917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8410 WADSWORTH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-0917
Practice Address - Country:US
Practice Address - Phone:303-425-9557
Practice Address - Fax:303-425-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODI657284OtherBLUE CROSS BLUE SHIELD
COC807151Medicare PIN