Provider Demographics
NPI:1306149190
Name:ROCK SOLID CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:ROCK SOLID CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANDI
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MIEDEMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-830-0431
Mailing Address - Street 1:11605 MERIDIAN MARKET VW
Mailing Address - Street 2:142
Mailing Address - City:FALCON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-8237
Mailing Address - Country:US
Mailing Address - Phone:719-799-6565
Mailing Address - Fax:719-302-0660
Practice Address - Street 1:11605 MERIDIAN MARKET VW
Practice Address - Street 2:142
Practice Address - City:FALCON
Practice Address - State:CO
Practice Address - Zip Code:80831-8237
Practice Address - Country:US
Practice Address - Phone:719-799-6565
Practice Address - Fax:719-302-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6596111N00000X
CO6600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty