1902076722 NPI number — OLD TOWN CHIROPRACTIC & MASSAGE, PLLC

Table of content: MS. DEBRA KAY LOWTHER LPC, PSYCHOLOGY (NPI 1063729515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902076722 NPI number — OLD TOWN CHIROPRACTIC & MASSAGE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLD TOWN CHIROPRACTIC & MASSAGE, PLLC
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:
1902076722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 S HOWES ST
Provider Second Line Business Mailing Address:
D107
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80521-2871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-377-0918
Provider Business Mailing Address Fax Number:
970-221-2437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 S HOWES ST
Provider Second Line Business Practice Location Address:
D107
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80521-2871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-377-0918
Provider Business Practice Location Address Fax Number:
970-221-2437
Provider Enumeration Date:
03/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CROSS
Authorized Official First Name:
ANGELIQUE
Authorized Official Middle Name:
KATHLEEN
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
970-377-0918

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5120 , 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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