Healthcare Provider Details

I. General information

NPI: 1073930731
Provider Name (Legal Business Name): TRANSFORMATION CHIROPRACTIC & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 BLICHMAN AVE SUITE 110
GRAND JUNCTION CO
81505-1092
US

IV. Provider business mailing address

2501 BLICHMAN AVE SUITE 110
GRAND JUNCTION CO
81505-1092
US

V. Phone/Fax

Practice location:
  • Phone: 970-812-5559
  • Fax: 888-972-6051
Mailing address:
  • Phone: 970-812-5559
  • Fax: 888-972-6051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR7006
License Number StateCO

VIII. Authorized Official

Name: DR. ANDREA JORDHEIM
Title or Position: MANAGING MEMBER
Credential: D.C.
Phone: 970-812-5559