Provider Demographics
NPI:1427120393
Name:DOWNTOWN CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:DOWNTOWN CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-440-6622
Mailing Address - Street 1:4801 RIVERBEND RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2613
Mailing Address - Country:US
Mailing Address - Phone:303-440-6622
Mailing Address - Fax:303-440-6623
Practice Address - Street 1:4801 RIVERBEND RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2613
Practice Address - Country:US
Practice Address - Phone:303-440-6622
Practice Address - Fax:303-440-6623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCOLO3145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804370Medicare PIN
COU05619Medicare UPIN