Provider Demographics
NPI:1124683438
Name:COLORADO SPINE AND REHAB CENTERS LLC
Entity type:Organization
Organization Name:COLORADO SPINE AND REHAB CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-706-6810
Mailing Address - Street 1:2020 N ACADEMY BLVD STE 155
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1569
Mailing Address - Country:US
Mailing Address - Phone:719-380-7210
Mailing Address - Fax:877-433-0832
Practice Address - Street 1:2020 N ACADEMY BLVD STE 155
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1569
Practice Address - Country:US
Practice Address - Phone:719-380-7210
Practice Address - Fax:877-433-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty