Provider Demographics
NPI:1659501435
Name:SUMMIT CHIROPRACTIC & REHABILITATION, P.C.
Entity type:Organization
Organization Name:SUMMIT CHIROPRACTIC & REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:IVO
Authorized Official - Middle Name:F
Authorized Official - Last Name:WAERLOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC,DABCN, CCSP, CCRD
Authorized Official - Phone:970-513-9234
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:114 VILLAGE PLACE STE 302
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-0300
Mailing Address - Country:US
Mailing Address - Phone:970-513-9234
Mailing Address - Fax:970-513-9238
Practice Address - Street 1:114 VILLAGE PLACE
Practice Address - Street 2:STE 302
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435-0300
Practice Address - Country:US
Practice Address - Phone:970-513-9234
Practice Address - Fax:970-513-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1154455939OtherNPI
CO1013041896OtherNPI