Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1555 | CO |
NPI | 1154429637 |
---|---|
Provider Name | Dr. Bernard Michael O'grady |
First Address | Englewood, CO 80110-6315 |
Second Address | Englewood, CO 80110-6315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14293 | (02) | CO |