Healthcare Provider Details

I. General information

NPI: 1285804559
Provider Name (Legal Business Name): VENEKAMP CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 E ELIZABETH #8
FORT COLLINS CO
80524-4040
US

IV. Provider business mailing address

1217 E ELIZABETH # 8
FORT COLLINS CO
80524-4040
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-0611
  • Fax: 970-493-7347
Mailing address:
  • Phone: 970-493-0611
  • Fax: 970-493-7347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5183
License Number StateCO

VII. Legacy identifiers

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

# 1
Identifier491098
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerGROUP MEDICARE

VIII. Authorized Official

Name: SARAH VENEKAMP
Title or Position: SECRETARY TREASURER
Credential:
Phone: 970-493-0611