Provider Demographics
NPI:1861703209
Name:BREITLOW CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BREITLOW CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BREITLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-366-5461
Mailing Address - Street 1:600 S AIRPORT RD
Mailing Address - Street 2:SUITE C BUILDING C
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6424
Mailing Address - Country:US
Mailing Address - Phone:804-366-5461
Mailing Address - Fax:
Practice Address - Street 1:600 S AIRPORT RD
Practice Address - Street 2:SUITE C BUILDING C
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-6424
Practice Address - Country:US
Practice Address - Phone:804-366-5461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty