1528254356 NPI number — CROSSROADS FAMILY CHIROPRACTIC, INC

Table of content: DANIELLE KELLEY BS, MAE, EDD (NPI 1225789613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528254356 NPI number — CROSSROADS FAMILY CHIROPRACTIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSSROADS FAMILY CHIROPRACTIC, INC
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:
1528254356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10789 BRADFORD RD
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80127-6403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-904-8641
Provider Business Mailing Address Fax Number:
303-904-8793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10789 BRADFORD RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80127-6403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-904-8641
Provider Business Practice Location Address Fax Number:
303-904-8793
Provider Enumeration Date:
09/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHORE
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-904-8641

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3672 , 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 © 2007-2025 www.npivalidator.com