Provider Demographics
NPI:1548626088
Name:MINEN, JOHN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:MINEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3260 CRIPPLE CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-7194
Mailing Address - Country:US
Mailing Address - Phone:330-421-4237
Mailing Address - Fax:855-667-9565
Practice Address - Street 1:2299 PEARL ST STE 105
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4669
Practice Address - Country:US
Practice Address - Phone:303-736-9343
Practice Address - Fax:855-667-9565
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009623111NS0005X
COCHR.0007584111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician