Provider Demographics
NPI:1881965994
Name:KINGDOM FAMILY CHIROPRACTIC INC.
Entity type:Organization
Organization Name:KINGDOM FAMILY CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BREAN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SYMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-717-6201
Mailing Address - Street 1:10160 W 50TH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2339
Mailing Address - Country:US
Mailing Address - Phone:720-542-3260
Mailing Address - Fax:720-328-5264
Practice Address - Street 1:10160 W 50TH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2339
Practice Address - Country:US
Practice Address - Phone:720-542-3260
Practice Address - Fax:720-328-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty