Fruita Chiropractic and Massage
Organization Active NPI Chiropractor · Fruita, CO
NPI 1316370463 · NPPES record last updated Apr 30, 2015
Key facts
- NPI
- 1316370463
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHR.0006988 (CO)
- Legal business name
- FRUITA CHIROPRACTIC AND MASSAGE
- Practice address
- 122 E Aspen Ave
Unit a
Fruita, CO 81521-2542 - Phone
- (970) 639-9730
- Fax
- (970) 639-9730
- NPI assigned
- Aug 13, 2013
- Organization subpart
- No
Authorized official
- Name
- Dr. Jonathan Edward Blaha, D.C.
- Title
- Owner
- Phone
- (970) 639-9730
Practitioners 1
-
Jonathan E Blaha, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151012001563 | CO | Part B Supplier - Clinic/Group Practice | 6901115039 |
Receives reassigned benefits from 1 practitioner Practice locations: Fruita, CO |
National Provider Directory
Locations
212 E Aspen Ave
Fruita, CO 81521
Phone (970) 639-9730
122 E Aspen Ave
Unit A
Fruita, CO 81521
Phone (970) 639-9730
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | CHR.0006988 | CO | Yes |
Addresses
Primary practice location
122 E Aspen Ave
Unit a
Fruita, CO 81521-2542
Mailing address
122 E Aspen Ave
Unit a
Fruita, CO 81521-2542
Phone (970) 639-9730
Other providers in Fruita, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.