Provider Demographics
NPI:1871786525
Name:SPINE CENTER OF COLORADO LLC
Entity type:Organization
Organization Name:SPINE CENTER OF COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:LANZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-678-9045
Mailing Address - Street 1:1248 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3824
Mailing Address - Country:US
Mailing Address - Phone:303-678-9045
Mailing Address - Fax:303-678-9046
Practice Address - Street 1:1248 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3824
Practice Address - Country:US
Practice Address - Phone:303-678-9045
Practice Address - Fax:303-678-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty