Provider Demographics
NPI:1710109095
Name:THOLE INC.
Entity Type:Organization
Organization Name:THOLE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-377-1810
Mailing Address - Street 1:2627 REDWING RD.
Mailing Address - Street 2:SUITE 235
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526
Mailing Address - Country:US
Mailing Address - Phone:970-377-1810
Mailing Address - Fax:970-377-1815
Practice Address - Street 1:2627 REDWING RD.
Practice Address - Street 2:SUITE 235
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526
Practice Address - Country:US
Practice Address - Phone:970-377-1810
Practice Address - Fax:970-377-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804276Medicare PIN
COV07770Medicare UPIN