Provider Demographics
NPI: | 1760665111 |
---|---|
Name: | YOUR CENTER CHIROPRACTIC |
Entity Type: | Organization |
Organization Name: | YOUR CENTER CHIROPRACTIC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | COOWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KATHRYN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FARMER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | HIRES CHIROPRACTOR |
Authorized Official - Phone: | 303-378-2567 |
Mailing Address - Street 1: | 10920 W. ALAMEDA AVE. |
Mailing Address - Street 2: | |
Mailing Address - City: | LAKEWOOD |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80226 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 303-989-1533 |
Mailing Address - Fax: | 303-989-1534 |
Practice Address - Street 1: | 10920 W. ALAMEDA AVE. |
Practice Address - Street 2: | |
Practice Address - City: | LAKEWOOD |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80226 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-989-1533 |
Practice Address - Fax: | 303-989-1534 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-12-07 |
Last Update Date: | 2007-12-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 5023 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |