Provider Demographics
NPI:1154558138
Name:SUNRISE CHIROPRACTIC CENTER P.C.
Entity type:Organization
Organization Name:SUNRISE CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-598-8288
Mailing Address - Street 1:7608 N UNION BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3886
Mailing Address - Country:US
Mailing Address - Phone:719-598-8288
Mailing Address - Fax:719-260-9899
Practice Address - Street 1:7608 N UNION BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3886
Practice Address - Country:US
Practice Address - Phone:719-598-8288
Practice Address - Fax:719-260-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO519188Medicare PIN