Provider Demographics
NPI:1962164657
Name:IMPRINT FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:IMPRINT FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WAREHIME
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-652-7745
Mailing Address - Street 1:7 S PARISH AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9099
Mailing Address - Country:US
Mailing Address - Phone:970-893-8969
Mailing Address - Fax:
Practice Address - Street 1:7 S PARISH AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9099
Practice Address - Country:US
Practice Address - Phone:970-893-8969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-10
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1679086631OtherINDIVIDUAL NPI NUMBER