1659425346 NPI number — CHIROPRACTIC DIMENSIONS LLC

Table of content: (NPI 1659425346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659425346 NPI number — CHIROPRACTIC DIMENSIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC DIMENSIONS LLC
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:
PHYSICAL DIMENSIONS INTEGRATIVE HEALTH GROUP
Provider Other Organization Name Type Code:
3
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:
1659425346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9068 FORSSTROM DR
Provider Second Line Business Mailing Address:
C-25
Provider Business Mailing Address City Name:
LONE TREE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80124-5577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-925-1050
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9068 FORSSTROM DR
Provider Second Line Business Practice Location Address:
C-25
Provider Business Practice Location Address City Name:
LONE TREE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80124-5577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-925-1050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FOWLER
Authorized Official First Name:
TYLER
Authorized Official Middle Name:
CORBIN
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
303-925-1050

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5889 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 5894 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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