Provider Demographics
NPI:1770891806
Name:LEFT HAND CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:LEFT HAND CHIROPRACTIC CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-651-7003
Mailing Address - Street 1:2350 17TH AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-1737
Mailing Address - Country:US
Mailing Address - Phone:303-651-7003
Mailing Address - Fax:
Practice Address - Street 1:2350 17TH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-1737
Practice Address - Country:US
Practice Address - Phone:303-651-7003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty