Provider Demographics
NPI:1013171982
Name:CANYON CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:CANYON CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AQUINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-402-1300
Mailing Address - Street 1:2595 CANYON BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6745
Mailing Address - Country:US
Mailing Address - Phone:303-402-1300
Mailing Address - Fax:303-402-1310
Practice Address - Street 1:2595 CANYON BLVD
Practice Address - Street 2:STE 240
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6745
Practice Address - Country:US
Practice Address - Phone:303-402-1300
Practice Address - Fax:303-402-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty