Provider Demographics
NPI:1942501093
Name:CT FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:CT FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-690-8471
Mailing Address - Street 1:6180 S GUN CLUB RD
Mailing Address - Street 2:STE. L-4
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5309
Mailing Address - Country:US
Mailing Address - Phone:303-690-8471
Mailing Address - Fax:303-690-8425
Practice Address - Street 1:6180 S GUN CLUB RD
Practice Address - Street 2:STE. L-4
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5309
Practice Address - Country:US
Practice Address - Phone:303-690-8471
Practice Address - Fax:303-690-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO164316251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4450Medicare UPIN