Provider Demographics
NPI:1023175767
Name:CHIROPRACTIQUE, ETC.
Entity type:Organization
Organization Name:CHIROPRACTIQUE, ETC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUEBEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SANTISTEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DIPL AC
Authorized Official - Phone:303-698-2225
Mailing Address - Street 1:1040 S GAYLORD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4682
Mailing Address - Country:US
Mailing Address - Phone:303-698-2225
Mailing Address - Fax:303-698-2890
Practice Address - Street 1:1040 S GAYLORD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4682
Practice Address - Country:US
Practice Address - Phone:303-698-2225
Practice Address - Fax:303-698-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty