Provider Demographics
NPI:1215982335
Name:MOUNTAIN CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:MOUNTAIN CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TREINEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-565-4800
Mailing Address - Street 1:1933 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3039
Mailing Address - Country:US
Mailing Address - Phone:970-565-4800
Mailing Address - Fax:970-565-0821
Practice Address - Street 1:1933 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3039
Practice Address - Country:US
Practice Address - Phone:970-565-4800
Practice Address - Fax:970-565-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT60610Medicare UPIN
COCK5303Medicare PIN