Provider Demographics
NPI:1447491352
Name:ROCKY MOUNTAIN CHIROPRACTIC AND SPORTS INJURY CENTERS
Entity type:Organization
Organization Name:ROCKY MOUNTAIN CHIROPRACTIC AND SPORTS INJURY CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C,E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:GARLAND
Authorized Official - Last Name:HEXTELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-674-0147
Mailing Address - Street 1:1230 W ASH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-4677
Mailing Address - Country:US
Mailing Address - Phone:970-674-0147
Mailing Address - Fax:970-674-0145
Practice Address - Street 1:1230 W ASH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4677
Practice Address - Country:US
Practice Address - Phone:970-674-0147
Practice Address - Fax:970-674-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6306261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4447Medicare PIN