Provider Demographics
NPI:1679706972
Name:ARVADA BACK PAIN CLINIC, INC.
Entity Type:Organization
Organization Name:ARVADA BACK PAIN CLINIC, INC.
Other - Org Name:CHRISTINE M. ANDERSON, DC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-429-3770
Mailing Address - Street 1:8787 TURNPIKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-4300
Mailing Address - Country:US
Mailing Address - Phone:303-429-3770
Mailing Address - Fax:303-429-8980
Practice Address - Street 1:8787 TURNPIKE DR STE 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-4300
Practice Address - Country:US
Practice Address - Phone:303-429-3770
Practice Address - Fax:303-429-8980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC47333Medicare UPIN