Provider Demographics
NPI:1376698787
Name:CANYON RIDGE CHIROPRACTIC PC
Entity type:Organization
Organization Name:CANYON RIDGE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUDIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-660-3505
Mailing Address - Street 1:7280 LAGAE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9452
Mailing Address - Country:US
Mailing Address - Phone:330-660-3505
Mailing Address - Fax:303-660-8905
Practice Address - Street 1:7280 LAGAE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-9452
Practice Address - Country:US
Practice Address - Phone:330-660-3505
Practice Address - Fax:303-660-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty