Provider Demographics
NPI:1285804559
Name:VENEKAMP CHIROPRACTIC PC
Entity type:Organization
Organization Name:VENEKAMP CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:VENEKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-493-0611
Mailing Address - Street 1:1217 E ELIZABETH
Mailing Address - Street 2:# 8
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4040
Mailing Address - Country:US
Mailing Address - Phone:970-493-0611
Mailing Address - Fax:970-493-7347
Practice Address - Street 1:1217 E ELIZABETH
Practice Address - Street 2:#8
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4040
Practice Address - Country:US
Practice Address - Phone:970-493-0611
Practice Address - Fax:970-493-7347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO491098OtherGROUP MEDICARE