Provider Demographics
NPI: | 1669830857 |
---|---|
Name: | LIFE SPRINGS FAMILY CHIROPRACTIC PC |
Entity Type: | Organization |
Organization Name: | LIFE SPRINGS FAMILY CHIROPRACTIC PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DOCTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JOSH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BEAUDRY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 303-770-0605 |
Mailing Address - Street 1: | 1355 S COLORADO BLVD |
Mailing Address - Street 2: | # C303 |
Mailing Address - City: | DENVER |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80222-3305 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 303-770-0605 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1355 S COLORADO BLVD |
Practice Address - Street 2: | # C303 |
Practice Address - City: | DENVER |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80222-3305 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-770-0605 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-02-03 |
Last Update Date: | 2019-11-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | DC6657 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |