Healthcare Provider Details

I. General information

NPI: 1104073998
Provider Name (Legal Business Name): COLUMBINE CHIROPRACTIC HEALTH CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 S CAMINO DEL RIO SUITE G
DURANGO CO
81303-7935
US

IV. Provider business mailing address

329 S CAMINO DEL RIO SUITE G
DURANGO CO
81303-7935
US

V. Phone/Fax

Practice location:
  • Phone: 970-259-0077
  • Fax: 970-259-6540
Mailing address:
  • Phone: 970-259-0077
  • Fax: 970-259-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2357
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ANTOINETTE HATALA NOWAKOWSKI
Title or Position: PRESIDENT
Credential: D.C., D.A.B.C.O.
Phone: 970-259-0077