Provider Demographics
NPI:1104616887
Name:MOUNTAINSIDE FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MOUNTAINSIDE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-484-8136
Mailing Address - Street 1:6565 W JEWELL AVE STE 12A
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-7102
Mailing Address - Country:US
Mailing Address - Phone:303-484-8136
Mailing Address - Fax:303-484-8371
Practice Address - Street 1:6565 W JEWELL AVE STE 12A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-7102
Practice Address - Country:US
Practice Address - Phone:303-484-8136
Practice Address - Fax:303-484-8371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty