Provider Demographics
NPI:1194948497
Name:SAGEBRUSH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SAGEBRUSH CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:HAFNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-989-0255
Mailing Address - Street 1:305 S KIPLING ST
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2700
Mailing Address - Country:US
Mailing Address - Phone:303-989-0255
Mailing Address - Fax:303-672-8212
Practice Address - Street 1:305 S KIPLING ST
Practice Address - Street 2:SUITE C-2
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2700
Practice Address - Country:US
Practice Address - Phone:303-989-0255
Practice Address - Fax:303-672-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty