Provider Demographics
NPI:1821139981
Name:KALLIO CHIROPRACTIC, PROF. LLC
Entity Type:Organization
Organization Name:KALLIO CHIROPRACTIC, PROF. LLC
Other - Org Name:ADVANTAGE CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:KALLIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-267-9600
Mailing Address - Street 1:4038 TIMBERLINE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6031
Mailing Address - Country:US
Mailing Address - Phone:970-267-9600
Mailing Address - Fax:970-267-2909
Practice Address - Street 1:4038 TIMBERLINE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-6031
Practice Address - Country:US
Practice Address - Phone:970-267-9600
Practice Address - Fax:970-267-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5751111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803146Medicare ID - Type UnspecifiedCORPORATE MEDICARE NUMBER