Provider Demographics
NPI:1194597575
Name:MONGILLO FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MONGILLO FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MONGILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-773-2500
Mailing Address - Street 1:11873 SPRINGS RD STE 125
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-7263
Mailing Address - Country:US
Mailing Address - Phone:720-773-2500
Mailing Address - Fax:
Practice Address - Street 1:11873 SPRINGS RD STE 125
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7263
Practice Address - Country:US
Practice Address - Phone:720-773-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty