Provider Demographics
NPI:1265109722
Name:COLORADO CHIROPRACTIC AND REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:COLORADO CHIROPRACTIC AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-401-5728
Mailing Address - Street 1:1700 BASSETT ST UNIT 816
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1920
Mailing Address - Country:US
Mailing Address - Phone:720-401-5728
Mailing Address - Fax:
Practice Address - Street 1:2460 W 26TH AVE STE 40C
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5341
Practice Address - Country:US
Practice Address - Phone:720-401-5728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty