Provider Demographics
NPI:1700054772
Name:SOUTHWEST ALTERNATIVE MEDICAL, INC.
Entity Type:Organization
Organization Name:SOUTHWEST ALTERNATIVE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:DC,CCSP
Authorized Official - Phone:970-259-1450
Mailing Address - Street 1:PO BOX 1211
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-1211
Mailing Address - Country:US
Mailing Address - Phone:970-259-1450
Mailing Address - Fax:970-259-1471
Practice Address - Street 1:523-A SOUTH CAMINO DEL RIO
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303
Practice Address - Country:US
Practice Address - Phone:970-259-1450
Practice Address - Fax:970-259-1471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1963111NS0005X
CODR-40091207Q00000X
CO5468363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty