Provider Demographics
NPI:1366850224
Name:ESSENTIAL FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ESSENTIAL FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-659-3128
Mailing Address - Street 1:30 S 20TH AVE
Mailing Address - Street 2:UNIT E
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-3705
Mailing Address - Country:US
Mailing Address - Phone:303-659-3128
Mailing Address - Fax:303-659-3130
Practice Address - Street 1:30 S 20TH AVE
Practice Address - Street 2:UNIT E
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3705
Practice Address - Country:US
Practice Address - Phone:303-659-3128
Practice Address - Fax:303-659-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty