Provider Demographics
NPI:1760785216
Name:100PERCENT A CHIROPRACTIC WELLNESS CENTER SOUTH DENVER LLC
Entity Type:Organization
Organization Name:100PERCENT A CHIROPRACTIC WELLNESS CENTER SOUTH DENVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-922-1007
Mailing Address - Street 1:455 S TELLER ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-7395
Mailing Address - Country:US
Mailing Address - Phone:303-922-1007
Mailing Address - Fax:303-922-9067
Practice Address - Street 1:455 S TELLER ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-7395
Practice Address - Country:US
Practice Address - Phone:303-922-1007
Practice Address - Fax:303-922-9067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty