Provider Demographics
NPI:1912183724
Name:ALIGN CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:ALIGN CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:MIKALAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-776-0882
Mailing Address - Street 1:1318 VIVIAN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3217
Mailing Address - Country:US
Mailing Address - Phone:303-776-0882
Mailing Address - Fax:303-776-1053
Practice Address - Street 1:1318 VIVIAN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3217
Practice Address - Country:US
Practice Address - Phone:303-776-0882
Practice Address - Fax:303-776-1053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-6064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty