NPIMap

Organization Active NPI

South Boulder Healing Center PLLC

  • Chiropractor
  • Boulder, CO
National Provider Identifier
1316129158
Registry record updated Jul 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2747 Issued in CO
Legal business name
SOUTH BOULDER HEALING CENTER PLLC
Practice address
4150 Darley Ave
Suite 6
Boulder, CO 80305-6537
Phone
(303) 499-5000
Fax
(303) 499-4962
NPI assigned
Dec 4, 2007
Last updated
Jul 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary G Elsea, DCNPI 1619066321
Title
President
Phone
(303) 499-5000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2747 CO Primary

Addresses

Primary practice location

4150 Darley Ave
Suite 6
Boulder, CO 80305-6537

Mailing address

4150 Darley Ave
Suite 6
Boulder, CO 80305-6537
Phone (303) 499-5000

National Provider Directory

National Provider Directory

Locations

4150 Darley Ave
Ste 6
Boulder, CO 80305
Phone (303) 499-5000

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1316129158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 DARLEY AVE",
            "address_2": "SUITE 6",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803056537",
            "telephone_number": "303-499-5000",
            "fax_number": "303-499-4962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 DARLEY AVE",
            "address_2": "SUITE 6",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803056537",
            "telephone_number": "303-499-5000",
            "fax_number": "303-499-4962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BOULDER HEALING CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "ELSEA",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-499-5000",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CO",
            "license": "2747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.