Provider Demographics
NPI:1194981159
Name:STINE CHIROPRACTIC HEALTH AND WELLNESS CLINIC, P.C.
Entity type:Organization
Organization Name:STINE CHIROPRACTIC HEALTH AND WELLNESS CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-674-0147
Mailing Address - Street 1:1230 W ASH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-4677
Mailing Address - Country:US
Mailing Address - Phone:970-674-0147
Mailing Address - Fax:970-674-0145
Practice Address - Street 1:1230 W ASH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4677
Practice Address - Country:US
Practice Address - Phone:970-674-0147
Practice Address - Fax:970-674-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC-453658Medicare PIN
COU72786Medicare UPIN