Provider Demographics
NPI:1821334137
Name:MEDICAL RESTORATION CENTERS, LLC
Entity Type:Organization
Organization Name:MEDICAL RESTORATION CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:GERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-266-0438
Mailing Address - Street 1:4760 FLINTRIDGE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4267
Mailing Address - Country:US
Mailing Address - Phone:719-266-0438
Mailing Address - Fax:
Practice Address - Street 1:4760 FLINTRIDGE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4267
Practice Address - Country:US
Practice Address - Phone:719-266-0438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty