Provider Demographics
NPI:1649462763
Name:COLORADO CHIROPRACTIC REHABILITATION
Entity type:Organization
Organization Name:COLORADO CHIROPRACTIC REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SLAVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELITS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-693-2225
Mailing Address - Street 1:4090 S PARKER RD
Mailing Address - Street 2:SUITE # 125
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-8121
Mailing Address - Country:US
Mailing Address - Phone:303-693-2225
Mailing Address - Fax:303-693-7670
Practice Address - Street 1:4090 S PARKER RD
Practice Address - Street 2:SUITE # 125
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-8121
Practice Address - Country:US
Practice Address - Phone:303-693-2225
Practice Address - Fax:303-693-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO803392Medicare PIN