Provider Demographics
NPI:1992097331
Name:GRAND JUNCTION CHIROPRACTIC CENTER, P.C.
Entity type:Organization
Organization Name:GRAND JUNCTION CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-241-1199
Mailing Address - Street 1:569 32 RD
Mailing Address - Street 2:STE 5C
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-7053
Mailing Address - Country:US
Mailing Address - Phone:970-263-0633
Mailing Address - Fax:970-263-4047
Practice Address - Street 1:569 32 RD
Practice Address - Street 2:STE 5C
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-7053
Practice Address - Country:US
Practice Address - Phone:970-263-0633
Practice Address - Fax:970-263-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCM0003Medicare PIN