Provider Demographics
NPI:1700836780
Name:CHIROPRACTIC RELEASE, INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC RELEASE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-470-4016
Mailing Address - Street 1:3011 BROADWAY ST
Mailing Address - Street 2:#11
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304
Mailing Address - Country:US
Mailing Address - Phone:720-470-4016
Mailing Address - Fax:303-499-5756
Practice Address - Street 1:3011 BROADWAY ST
Practice Address - Street 2:#11
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3100
Practice Address - Country:US
Practice Address - Phone:720-470-4016
Practice Address - Fax:303-499-5756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty