Provider Demographics
NPI:1902177397
Name:WAKITA CHIROPRACTIC OFFICE, P.C.
Entity Type:Organization
Organization Name:WAKITA CHIROPRACTIC OFFICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-224-2263
Mailing Address - Street 1:220 W PROSPECT RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2094
Mailing Address - Country:US
Mailing Address - Phone:970-224-4852
Mailing Address - Fax:970-224-0928
Practice Address - Street 1:220 W PROSPECT RD
Practice Address - Street 2:SUITE D
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2094
Practice Address - Country:US
Practice Address - Phone:970-224-4852
Practice Address - Fax:970-224-0928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23173Medicare PIN