Provider Demographics
NPI:1306171228
Name:CHIROPRACTIC DIMENSIONS OF MEAD LLC
Entity type:Organization
Organization Name:CHIROPRACTIC DIMENSIONS OF MEAD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:CORBIN
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-925-1050
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:CO
Mailing Address - Zip Code:80542-0745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 MAIN ST UNIT E
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:CO
Practice Address - Zip Code:80542
Practice Address - Country:US
Practice Address - Phone:970-535-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2010-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5894111N00000X
225100000X
CO5889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty