Provider Demographics
NPI:1588114987
Name:HEALTHSOURCE OF HIGHLANDS RANCH WEST LLC.
Entity type:Organization
Organization Name:HEALTHSOURCE OF HIGHLANDS RANCH WEST LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-470-1020
Mailing Address - Street 1:9249 S BROADWAY
Mailing Address - Street 2:UNIT 100
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-5690
Mailing Address - Country:US
Mailing Address - Phone:303-470-1020
Mailing Address - Fax:303-470-1702
Practice Address - Street 1:9249 S BROADWAY
Practice Address - Street 2:UNIT 100
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-5690
Practice Address - Country:US
Practice Address - Phone:303-470-1020
Practice Address - Fax:303-470-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20161654184111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty