Provider Demographics
NPI:1336442169
Name:CROSSROAD RADIOLOGY AND DIAGNOSTIC SERVICES, P.C.
Entity Type:Organization
Organization Name:CROSSROAD RADIOLOGY AND DIAGNOSTIC SERVICES, P.C.
Other - Org Name:CROSSROAD RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHIDDEN
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:719-593-0300
Mailing Address - Street 1:9420 BRIAR VILLAGE PT
Mailing Address - Street 2:SUITE #130
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7921
Mailing Address - Country:US
Mailing Address - Phone:719-593-0300
Mailing Address - Fax:719-593-1451
Practice Address - Street 1:9420 BRIAR VILLAGE PT
Practice Address - Street 2:SUITE #130
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7921
Practice Address - Country:US
Practice Address - Phone:719-593-0300
Practice Address - Fax:719-593-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6525111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty