Provider Demographics
NPI:1407284920
Name:INTEGRATED HEALTH CENTER OF THE ROCKIES LLC
Entity type:Organization
Organization Name:INTEGRATED HEALTH CENTER OF THE ROCKIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIELS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-353-9774
Mailing Address - Street 1:7555 E HAMPDEN AVE
Mailing Address - Street 2:420
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7555 E HAMPDEN AVE
Practice Address - Street 2:420
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4830
Practice Address - Country:US
Practice Address - Phone:303-353-9774
Practice Address - Fax:303-923-3276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty