Provider Demographics
NPI:1730652744
Name:ALPINE CHIROPRACTIC AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:ALPINE CHIROPRACTIC AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CONNAUGHTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-460-2347
Mailing Address - Street 1:1310 ALPINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1310 ALPINE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3504
Practice Address - Country:US
Practice Address - Phone:860-460-2347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPINE CHIROPRACTIC AND REHABILITATION CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty