Provider Demographics
NPI:1780806737
Name:GOOD NEWS CHIROPRACTIC, PC
Entity type:Organization
Organization Name:GOOD NEWS CHIROPRACTIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:EMERY
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-252-8255
Mailing Address - Street 1:101 N UNCOMPAHGRE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401
Mailing Address - Country:US
Mailing Address - Phone:970-252-8255
Mailing Address - Fax:970-252-9280
Practice Address - Street 1:101 N UNCOMPAHGRE
Practice Address - Street 2:SUITE 1
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401
Practice Address - Country:US
Practice Address - Phone:970-252-8255
Practice Address - Fax:970-252-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR3842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO800840OtherGROUP NUMBER
CO800840OtherGROUP NUMBER