Provider Demographics
NPI:1912413345
Name:CHIROSPORT CHIROPRACTIC CLINIC INC.
Entity Type:Organization
Organization Name:CHIROSPORT CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-498-1691
Mailing Address - Street 1:6155 S MAIN ST STE 285
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5364
Mailing Address - Country:US
Mailing Address - Phone:303-617-7199
Mailing Address - Fax:
Practice Address - Street 1:6155 S MAIN ST STE 285
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5364
Practice Address - Country:US
Practice Address - Phone:303-617-7199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty