1780864108 NPI number — INNER BALANCE CHIROPRACTIC, P.C.

Table of content: MRS. MICHELLE MARIE HEXT APRN (NPI 1093912511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780864108 NPI number — INNER BALANCE CHIROPRACTIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNER BALANCE CHIROPRACTIC, P.C.
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:
1780864108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1410 WINDING RIDGE TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80919-1040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 E DRAKE RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80525-1787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-351-6099
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GENTILE
Authorized Official First Name:
TATE
Authorized Official Middle Name:
GRIFFIN
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
719-351-6099

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  6118 , 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)





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