Provider Demographics
NPI:1679776637
Name:SUMMEY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:SUMMEY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUMMEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-776-2939
Mailing Address - Street 1:421 21ST AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1469
Mailing Address - Country:US
Mailing Address - Phone:303-776-2939
Mailing Address - Fax:303-776-3391
Practice Address - Street 1:421 21ST AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1469
Practice Address - Country:US
Practice Address - Phone:303-776-2939
Practice Address - Fax:303-776-3391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1507111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08150708Medicaid
CO08150708Medicaid