Provider Demographics
NPI:1982841409
Name:SPECIALIZED SPINE ASSOCIATES
Entity Type:Organization
Organization Name:SPECIALIZED SPINE ASSOCIATES
Other - Org Name:MILE HIGH CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-452-2690
Mailing Address - Street 1:3953 E 120TH AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-2091
Mailing Address - Country:US
Mailing Address - Phone:303-452-2690
Mailing Address - Fax:303-452-1344
Practice Address - Street 1:3953 E 120TH AVE
Practice Address - Street 2:UNIT B
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-2091
Practice Address - Country:US
Practice Address - Phone:303-452-2690
Practice Address - Fax:303-452-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty