Provider Demographics
NPI:1174719900
Name:M5 CHIROPRACTIC PROFESSIONAL LLC
Entity type:Organization
Organization Name:M5 CHIROPRACTIC PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MORET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-904-8641
Mailing Address - Street 1:10789 W BRADFORD RD
Mailing Address - Street 2:STE 110
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-6404
Mailing Address - Country:US
Mailing Address - Phone:303-904-8641
Mailing Address - Fax:303-904-8793
Practice Address - Street 1:10789 W BRADFORD RD
Practice Address - Street 2:STE 110
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-6404
Practice Address - Country:US
Practice Address - Phone:303-904-8641
Practice Address - Fax:303-904-8793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804646Medicare PIN