Provider Demographics
NPI:1881835445
Name:ST VRAIN WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ST VRAIN WELLNESS CENTER LLC
Other - Org Name:PINNACLE HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-272-9000
Mailing Address - Street 1:6775 RANGEVIEW DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918
Mailing Address - Country:US
Mailing Address - Phone:719-272-9000
Mailing Address - Fax:719-272-9800
Practice Address - Street 1:6775 RANGEVIEW DR
Practice Address - Street 2:SUITE 120
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-272-9000
Practice Address - Fax:719-272-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty