Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHR-6429 | CO |
N | 111NN1001X | Nutrition | CHR-6429 | CO |
NPI | 1639406127 |
---|---|
Provider Name | Dr. Benjamin J Gottsche |
First Address | Arvada, CO 80002-1243 |
Second Address | Arvada, CO 80002-1243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2009 |
Last Update Date | 05/11/2010 |