Provider Demographics
NPI:1386336881
Name:EMPOWERED CHIROPRACTIC
Entity type:Organization
Organization Name:EMPOWERED CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FERDARKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-925-3860
Mailing Address - Street 1:1048 21 RD
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-9319
Mailing Address - Country:US
Mailing Address - Phone:678-925-3860
Mailing Address - Fax:
Practice Address - Street 1:2412 PATTERSON RD STE 5
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1259
Practice Address - Country:US
Practice Address - Phone:970-628-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty