Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 6306 | CO |
N | 111NR0400X | Rehabilitation Chiropractor | 6306 | CO |
Y | 111NS0005X | Chiropractic Sports Physician | 6306 | CO |
N | 111NX0100X | Occupational Health | 6306 | CO |
NPI | 1013162791 |
---|---|
Provider Name | Dr. Brent Garland Hextell |
First Address | Windsor, CO 80550-4677 |
Second Address | Windsor, CO 80550-4677 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2008 |
Last Update Date | 23/11/2008 |