Provider Demographics
NPI:1801190384
Name:ROCKY MTN CHIROPRACTIC & SPORTS REHAB PLLC
Entity Type:Organization
Organization Name:ROCKY MTN CHIROPRACTIC & SPORTS REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/GENERAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LOPARCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-535-9900
Mailing Address - Street 1:1880 DUBLIN BLVD
Mailing Address - Street 2:STE. E
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1293
Mailing Address - Country:US
Mailing Address - Phone:719-535-9900
Mailing Address - Fax:719-535-9901
Practice Address - Street 1:1880 DUBLIN BLVD
Practice Address - Street 2:STE. E
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1293
Practice Address - Country:US
Practice Address - Phone:719-535-9900
Practice Address - Fax:719-535-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-4715111NN0400X, 111NR0200X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO443388OtherMEDICARE ID