Provider Demographics
NPI:1104073998
Name:COLUMBINE CHIROPRACTIC HEALTH CENTER, PC
Entity type:Organization
Organization Name:COLUMBINE CHIROPRACTIC HEALTH CENTER, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:HATALA
Authorized Official - Last Name:NOWAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DABCO
Authorized Official - Phone:970-259-0077
Mailing Address - Street 1:329 S CAMINO DEL RIO
Mailing Address - Street 2:SUITE G
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-7935
Mailing Address - Country:US
Mailing Address - Phone:970-259-0077
Mailing Address - Fax:970-259-6540
Practice Address - Street 1:329 S CAMINO DEL RIO
Practice Address - Street 2:SUITE G
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-7935
Practice Address - Country:US
Practice Address - Phone:970-259-0077
Practice Address - Fax:970-259-6540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2357111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC23103Medicare UPIN