Healthcare Provider Details

I. General information

NPI: 1508786823
Provider Name (Legal Business Name): COAL CREEK CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W BASELINE RD
LAFAYETTE CO
80026-1719
US

IV. Provider business mailing address

310 W BASELINE RD
LAFAYETTE CO
80026-1719
US

V. Phone/Fax

Practice location:
  • Phone: 407-908-8064
  • Fax:
Mailing address:
  • Phone: 407-908-8064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ANDREW JOHNSTON
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 407-908-8064