Provider Demographics
NPI:1386937951
Name:PORTENIER CHIROPRACTIC, PC
Entity type:Organization
Organization Name:PORTENIER CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:PORTENIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-972-0800
Mailing Address - Street 1:7373 W JEFFERSON AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2051
Mailing Address - Country:US
Mailing Address - Phone:303-972-0800
Mailing Address - Fax:303-972-4132
Practice Address - Street 1:7373 W JEFFERSON AVE STE 402
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2051
Practice Address - Country:US
Practice Address - Phone:303-972-0800
Practice Address - Fax:303-972-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty