Provider Demographics
NPI:1871896480
Name:PREMIER HEALTH & LONGEVITY CENTER
Entity type:Organization
Organization Name:PREMIER HEALTH & LONGEVITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PATERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-344-8469
Mailing Address - Street 1:6208 LEHMAN DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8408
Mailing Address - Country:US
Mailing Address - Phone:719-344-8469
Mailing Address - Fax:
Practice Address - Street 1:6208 LEHMAN DR
Practice Address - Street 2:SUITE 225
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8408
Practice Address - Country:US
Practice Address - Phone:719-344-8469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty