1619050192 NPI number — STJERNHOLM BROTHERS FAMILY CHIROPRATIC

Table of content: (NPI 1619050192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619050192 NPI number — STJERNHOLM BROTHERS FAMILY CHIROPRATIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STJERNHOLM BROTHERS FAMILY CHIROPRATIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619050192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1910
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVERTHORNE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80498-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-468-9555
Provider Business Mailing Address Fax Number:
970-468-0948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 NORTH SUMMIT BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-376-5955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STJERNHOLM
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
GENERAL PARTNER
Authorized Official Telephone Number:
970-468-9555

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3244 AND 3306 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com