Provider Demographics
NPI:1063589190
Name:PRIMARY CARE AND CHIROPRACTIC INC
Entity type:Organization
Organization Name:PRIMARY CARE AND CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COM
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-683-3377
Mailing Address - Street 1:2963 DANBURY AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-8023
Mailing Address - Country:US
Mailing Address - Phone:303-683-8935
Mailing Address - Fax:
Practice Address - Street 1:9299 S BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-5603
Practice Address - Country:US
Practice Address - Phone:303-683-3377
Practice Address - Fax:303-683-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCK5203Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER