Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1593 | CO |
NPI | 1699866749 |
---|---|
Provider Name | Dr. Craig Gordon Wenborg |
First Address | Fort Collins, CO 80525-6273 |
Second Address | Fort Collins, CO 80525-6273 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
604567 | ACN (01) | CO |