Provider Demographics
NPI:1063782530
Name:SAND CREEK CHIROPRACTIC GROUP
Entity type:Organization
Organization Name:SAND CREEK CHIROPRACTIC GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:DURANSO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-597-7553
Mailing Address - Street 1:5265N ACADEMY BLVD
Mailing Address - Street 2:STE 1100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4042
Mailing Address - Country:US
Mailing Address - Phone:719-597-7553
Mailing Address - Fax:719-597-7554
Practice Address - Street 1:5265N ACADEMY BLVD
Practice Address - Street 2:STE 1100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4042
Practice Address - Country:US
Practice Address - Phone:719-597-7553
Practice Address - Fax:719-597-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3903111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty