Provider Demographics
NPI:1144372855
Name:CHIROPRACTIC HEALTH CENTER PC
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC OWNER OF CHI
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SIDNEY
Authorized Official - Last Name:WALTHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:710-544-1468
Mailing Address - Street 1:255 WEST ABRIENDO AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1870
Mailing Address - Country:US
Mailing Address - Phone:718-544-1468
Mailing Address - Fax:719-543-2357
Practice Address - Street 1:255 WEST ABRIENDO AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1870
Practice Address - Country:US
Practice Address - Phone:718-544-1468
Practice Address - Fax:719-543-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI3589OtherRAILROAD MC
C48903Medicare ID - Type Unspecified