Provider Demographics
NPI:1891844601
Name:AMSDEN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:AMSDEN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:AMSDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-494-2088
Mailing Address - Street 1:3472 RESEARCH PKWY STE 104
Mailing Address - Street 2:PMB 224
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1066
Mailing Address - Country:US
Mailing Address - Phone:719-494-2088
Mailing Address - Fax:719-282-6464
Practice Address - Street 1:8842 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7798
Practice Address - Country:US
Practice Address - Phone:719-494-2088
Practice Address - Fax:719-282-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO497048Medicare ID - Type UnspecifiedMEDICARE GROUP ID