Provider Demographics
NPI:1013636273
Name:REPUBLIC COLLABORATIVE CARE
Entity Type:Organization
Organization Name:REPUBLIC COLLABORATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-765-5733
Mailing Address - Street 1:1712 W UINTAH ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2958
Mailing Address - Country:US
Mailing Address - Phone:970-765-5733
Mailing Address - Fax:
Practice Address - Street 1:1712 W UINTAH ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2958
Practice Address - Country:US
Practice Address - Phone:970-765-5733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty