Provider Demographics
NPI:1720308844
Name:SHERIDAN PARK CHIROPRACTIC CENTER P C
Entity type:Organization
Organization Name:SHERIDAN PARK CHIROPRACTIC CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NHU
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIEU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-429-4104
Mailing Address - Street 1:8753 YATES DR
Mailing Address - Street 2:BUILDING 2, SUITE 104
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6947
Mailing Address - Country:US
Mailing Address - Phone:303-429-4104
Mailing Address - Fax:303-429-4171
Practice Address - Street 1:8753 YATES DR
Practice Address - Street 2:BUILDING 2, SUITE 104
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6947
Practice Address - Country:US
Practice Address - Phone:303-429-4104
Practice Address - Fax:303-429-4171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty