Provider Demographics
NPI:1750563516
Name:CASTLE PINES CHIROPRACTIC CENTER, P.C.
Entity type:Organization
Organization Name:CASTLE PINES CHIROPRACTIC CENTER, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:303-814-8000
Mailing Address - Street 1:562 E CASTLE PINES PKWY
Mailing Address - Street 2:SUITE C-6B
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-4609
Mailing Address - Country:US
Mailing Address - Phone:303-814-8000
Mailing Address - Fax:
Practice Address - Street 1:562 E CASTLE PINES PKWY
Practice Address - Street 2:SUITE C-6B
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-4609
Practice Address - Country:US
Practice Address - Phone:303-814-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4569111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU19432Medicare UPIN
COC802223Medicare PIN