Healthcare Provider Details

I. General information

NPI: 1013636273
Provider Name (Legal Business Name): REPUBLIC COLLABORATIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 W UINTAH ST
COLORADO SPRINGS CO
80904-2958
US

IV. Provider business mailing address

1712 W UINTAH ST
COLORADO SPRINGS CO
80904-2958
US

V. Phone/Fax

Practice location:
  • Phone: 970-765-5733
  • Fax:
Mailing address:
  • Phone: 970-765-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: CANDICE KINGSMAN
Title or Position: PRESIDENT
Credential:
Phone: 970-765-5733