Provider Demographics
NPI:1710397633
Name:100 PERCENT CHIROPRACTIC COLORADO SPRINGS FOUR, LLC
Entity Type:Organization
Organization Name:100 PERCENT CHIROPRACTIC COLORADO SPRINGS FOUR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-358-7422
Mailing Address - Street 1:6906 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1127
Mailing Address - Country:US
Mailing Address - Phone:719-358-7422
Mailing Address - Fax:719-375-5934
Practice Address - Street 1:6906 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1127
Practice Address - Country:US
Practice Address - Phone:719-358-7422
Practice Address - Fax:719-375-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006833305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization