1891980488 NPI number — LATTA CHIROPRACTIC CLINICS

Table of content: MARSHALL DEAN SHOEMAKER MD (NPI 1659321065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891980488 NPI number — LATTA CHIROPRACTIC CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LATTA CHIROPRACTIC CLINICS
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:
1891980488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12144 S GRASS RIVER TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80134-3195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-343-1357
Provider Business Mailing Address Fax Number:
303-343-3036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
651 POTOMAC ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80011-6731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-343-1357
Provider Business Practice Location Address Fax Number:
303-343-3036
Provider Enumeration Date:
09/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LATTA
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
303-343-1357

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  5164 , 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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