Provider Demographics
NPI:1962541755
Name:THOMPSON VALLEY CHIROPRACTIC PC
Entity type:Organization
Organization Name:THOMPSON VALLEY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:HOLM JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-203-0597
Mailing Address - Street 1:2180 W EISENHOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3146
Mailing Address - Country:US
Mailing Address - Phone:970-203-0597
Mailing Address - Fax:
Practice Address - Street 1:2180 W EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3146
Practice Address - Country:US
Practice Address - Phone:970-203-0597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCJ0303Medicare ID - Type Unspecified