Provider Demographics
NPI:1912229139
Name:NATURALLY CHIROPRACTIC & WELLNESS CENTER PC
Entity type:Organization
Organization Name:NATURALLY CHIROPRACTIC & WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-420-4270
Mailing Address - Street 1:12330 W 58TH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1200
Mailing Address - Country:US
Mailing Address - Phone:303-420-4270
Mailing Address - Fax:
Practice Address - Street 1:12330 W 58TH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1200
Practice Address - Country:US
Practice Address - Phone:303-420-4270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-6429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO41358Medicare PIN
COCOB5020Medicare PIN