Provider Demographics
NPI:1699968271
Name:CHIROPRACTIC LIFESTYLES, PC
Entity type:Organization
Organization Name:CHIROPRACTIC LIFESTYLES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:W
Authorized Official - Last Name:CAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-475-2455
Mailing Address - Street 1:2812 W COLORADO AVE
Mailing Address - Street 2:SUITE # 104
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2470
Mailing Address - Country:US
Mailing Address - Phone:719-475-2455
Mailing Address - Fax:719-475-2254
Practice Address - Street 1:11605 MERIDIAN MARKET VW
Practice Address - Street 2:SUITE # 142
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-8237
Practice Address - Country:US
Practice Address - Phone:719-475-2455
Practice Address - Fax:719-475-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COB65742OtherUPIN
1891822193OtherGROUP NPI
COSA666803OtherANTHEM BCBS
COSA666803OtherANTHEM BCBS
COC47833Medicare UPIN