Provider Demographics
NPI:1760924401
Name:BIOKINETICAPPLIEDSPINECARE&INTEGRATIVECLINICREHABILITATIVECHIROPRACTIC
Entity Type:Organization
Organization Name:BIOKINETICAPPLIEDSPINECARE&INTEGRATIVECLINICREHABILITATIVECHIROPRACTIC
Other - Org Name:BASIC REHABILITATIVE CHIROPRACTIC, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/HEAD CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-240-9091
Mailing Address - Street 1:121 S MADISON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3031
Mailing Address - Country:US
Mailing Address - Phone:720-240-9091
Mailing Address - Fax:720-240-9091
Practice Address - Street 1:121 S MADISON ST
Practice Address - Street 2:SUITE C
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3031
Practice Address - Country:US
Practice Address - Phone:720-240-9091
Practice Address - Fax:720-240-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007484111NX0800X
PADC011181111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty