Provider Demographics
NPI:1104062157
Name:FAMILY TREE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:FAMILY TREE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-765-4757
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:FLAGLER
Mailing Address - State:CO
Mailing Address - Zip Code:80815-0321
Mailing Address - Country:US
Mailing Address - Phone:719-765-4757
Mailing Address - Fax:
Practice Address - Street 1:231 QUANDARY AVENUE
Practice Address - Street 2:
Practice Address - City:FLAGLER
Practice Address - State:CO
Practice Address - Zip Code:80815-0321
Practice Address - Country:US
Practice Address - Phone:719-765-4757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty