Provider Demographics
NPI:1780761437
Name:ROBERT SMALL CHIROPRACTIC PC
Entity type:Organization
Organization Name:ROBERT SMALL CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-708-8839
Mailing Address - Street 1:10160 BLUFFMONT LN
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5570
Mailing Address - Country:US
Mailing Address - Phone:720-879-8145
Mailing Address - Fax:
Practice Address - Street 1:9898 ROSEMONT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-4106
Practice Address - Country:US
Practice Address - Phone:720-879-8145
Practice Address - Fax:720-879-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HEA5410OtherBLUE CROSS BLUE SHIELD
48863Medicare ID - Type Unspecified