Provider Demographics
NPI:1245473636
Name:CHAMPION CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:CHAMPION CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KRAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-249-4213
Mailing Address - Street 1:PO BOX 3623
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402-3623
Mailing Address - Country:US
Mailing Address - Phone:970-249-4213
Mailing Address - Fax:970-240-8094
Practice Address - Street 1:700 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3975
Practice Address - Country:US
Practice Address - Phone:970-249-4213
Practice Address - Fax:970-240-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty