Provider Demographics
NPI:1760665111
Name:YOUR CENTER CHIROPRACTIC
Entity type:Organization
Organization Name:YOUR CENTER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:HIRES CHIROPRACTOR
Authorized Official - Phone:303-378-2567
Mailing Address - Street 1:10920 W. ALAMEDA AVE.
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226
Mailing Address - Country:US
Mailing Address - Phone:303-989-1533
Mailing Address - Fax:303-989-1534
Practice Address - Street 1:10920 W. ALAMEDA AVE.
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226
Practice Address - Country:US
Practice Address - Phone:303-989-1533
Practice Address - Fax:303-989-1534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty