Provider Demographics
NPI:1710255260
Name:DIVERSIFIED CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:DIVERSIFIED CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-439-9354
Mailing Address - Street 1:1700 W 100TH AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80260-8004
Mailing Address - Country:US
Mailing Address - Phone:303-439-9354
Mailing Address - Fax:303-635-1066
Practice Address - Street 1:1700 W 100TH AVE
Practice Address - Street 2:STE 102
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80260-8004
Practice Address - Country:US
Practice Address - Phone:303-439-9354
Practice Address - Fax:303-635-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSAS2865OtherBLUE CROSS BLUE SHIELD
COC803285OtherMEDICARE ID
CO448767Medicare UPIN