Provider Demographics
NPI:1154595478
Name:NORTH COLORADO CLINIC OF CHIROPRACTIC, PC
Entity type:Organization
Organization Name:NORTH COLORADO CLINIC OF CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-684-8380
Mailing Address - Street 1:1240 KEN PRATT BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6300
Mailing Address - Country:US
Mailing Address - Phone:303-684-8380
Mailing Address - Fax:303-684-8381
Practice Address - Street 1:1240 KEN PRATT BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6300
Practice Address - Country:US
Practice Address - Phone:303-684-8380
Practice Address - Fax:303-684-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty