Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 19671 | CO |
NPI | 1023178324 |
---|---|
Provider Name | Dr. Alan Bruce Lichtenberg |
First Address | Denver, CO 80210-1628 |
Second Address | Denver, CO 80210-1628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |