Provider Demographics
NPI:1831438605
Name:CENTER FOR ALTERNATIVE MEDICINE, PLLC
Entity type:Organization
Organization Name:CENTER FOR ALTERNATIVE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-544-2009
Mailing Address - Street 1:2505 KACHINA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1573
Mailing Address - Country:US
Mailing Address - Phone:719-544-2009
Mailing Address - Fax:719-253-7734
Practice Address - Street 1:2505 KACHINA DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1573
Practice Address - Country:US
Practice Address - Phone:719-544-2009
Practice Address - Fax:719-253-7734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2788111N00000X
CO6677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty