Provider Demographics
NPI:1750501235
Name:KINETIC BODY IN BALANCE A COLORADO
Entity Type:Organization
Organization Name:KINETIC BODY IN BALANCE A COLORADO
Other - Org Name:ACTIVE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-933-9149
Mailing Address - Street 1:5935 S ZANG ST
Mailing Address - Street 2:STE. 275
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4647
Mailing Address - Country:US
Mailing Address - Phone:303-933-9149
Mailing Address - Fax:303-933-9110
Practice Address - Street 1:5935 S ZANG ST
Practice Address - Street 2:STE. 275
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4647
Practice Address - Country:US
Practice Address - Phone:303-933-9149
Practice Address - Fax:303-933-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5997111N00000X
CO5996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
809365Medicare UPIN