Provider Demographics
NPI:1063567253
Name:FRONT RANGE CHIROPRACTIC HEALTHCARE
Entity type:Organization
Organization Name:FRONT RANGE CHIROPRACTIC HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAXFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-432-3301
Mailing Address - Street 1:7355 W 88TH AVE
Mailing Address - Street 2:UNIT R
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-6476
Mailing Address - Country:US
Mailing Address - Phone:303-432-3301
Mailing Address - Fax:303-432-3063
Practice Address - Street 1:7355 W 88TH AVE
Practice Address - Street 2:UNIT R
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-6476
Practice Address - Country:US
Practice Address - Phone:303-432-3301
Practice Address - Fax:303-432-3063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO493898Medicare ID - Type Unspecified
COU95159Medicare UPIN