Provider Demographics
NPI:1982894549
Name:STONE-CREDEUR FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:STONE-CREDEUR FAMILY CHIROPRACTIC, PC
Other - Org Name:AK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ALEECE
Authorized Official - Last Name:CREDEUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-302-0930
Mailing Address - Street 1:4155 E JEWELL AVE
Mailing Address - Street 2:SUITE 1018
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4504
Mailing Address - Country:US
Mailing Address - Phone:303-302-0930
Mailing Address - Fax:303-302-0933
Practice Address - Street 1:4155 E JEWELL AVE
Practice Address - Street 2:SUITE 1018
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4504
Practice Address - Country:US
Practice Address - Phone:303-302-0930
Practice Address - Fax:303-302-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COV00435Medicare UPIN
CO502078Medicare PIN