Provider Demographics
NPI:1831617000
Name:ROCK SOLID CHIROPRACTIC AT CITADEL, PLLC
Entity type:Organization
Organization Name:ROCK SOLID CHIROPRACTIC AT CITADEL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MIEDEMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-799-6565
Mailing Address - Street 1:3510 GALLEY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4353
Mailing Address - Country:US
Mailing Address - Phone:719-799-6565
Mailing Address - Fax:719-213-2570
Practice Address - Street 1:3510 GALLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4353
Practice Address - Country:US
Practice Address - Phone:719-799-6565
Practice Address - Fax:719-213-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty