Provider Demographics
NPI:1285927392
Name:ALPINE FAMILY CHIROPRACTIC, INC
Entity type:Organization
Organization Name:ALPINE FAMILY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-838-7700
Mailing Address - Street 1:28529 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-7261
Mailing Address - Country:US
Mailing Address - Phone:303-838-7700
Mailing Address - Fax:303-838-4027
Practice Address - Street 1:28529 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7261
Practice Address - Country:US
Practice Address - Phone:303-838-7700
Practice Address - Fax:303-838-4027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty