Basic Information
| Provider Information | |||||||||
| NPI: | 1124683438 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLORADO SPINE AND REHAB CENTERS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 N ACADEMY BLVD STE 155 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809091569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193807210 | ||||||||
| FaxNumber: | 8774330832 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 N ACADEMY BLVD STE 155 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809091569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193807210 | ||||||||
| FaxNumber: | 8774330832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2019 | ||||||||
| LastUpdateDate: | 05/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | FARRELL | ||||||||
| AuthorizedOfficialFirstName: | MARTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2077066810 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.