Provider Demographics
NPI:1720262884
Name:DELVECCHIO BACK AND NECK CARE CENTER PC
Entity type:Organization
Organization Name:DELVECCHIO BACK AND NECK CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DELVECCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-422-3657
Mailing Address - Street 1:PO BOX 1588
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80306-1588
Mailing Address - Country:US
Mailing Address - Phone:303-442-5492
Mailing Address - Fax:303-447-3610
Practice Address - Street 1:7595 W 66TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-3909
Practice Address - Country:US
Practice Address - Phone:303-422-3657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO801106Medicare PIN