Provider Demographics
NPI:1790935708
Name:HEATHER A MEINKE LLC
Entity Type:Organization
Organization Name:HEATHER A MEINKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MEINKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-494-2800
Mailing Address - Street 1:4800 BASELINE RD
Mailing Address - Street 2:SUITE C-110
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2699
Mailing Address - Country:US
Mailing Address - Phone:303-494-2800
Mailing Address - Fax:303-499-8007
Practice Address - Street 1:4800 BASELINE RD
Practice Address - Street 2:SUITE C-110
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2699
Practice Address - Country:US
Practice Address - Phone:303-494-2800
Practice Address - Fax:303-499-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U89678Medicare UPIN
COC808339Medicare PIN