Provider Demographics
NPI:1306112891
Name:LIFE SPRINGS FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:LIFE SPRINGS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-770-0605
Mailing Address - Street 1:7200 E DRY CREEK RD STE G101
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2574
Mailing Address - Country:US
Mailing Address - Phone:303-770-0605
Mailing Address - Fax:
Practice Address - Street 1:7200 E DRY CREEK RD STE G101
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2574
Practice Address - Country:US
Practice Address - Phone:303-770-0605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO66111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty