Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 5527 | CO |
NPI | 1265563274 |
---|---|
Provider Name | Dr. Holly Rede Geersen |
First Address | Aurora, CO 80014-4131 |
Second Address | Aurora, CO 80014-4131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11513075 | CAQH PIN (01) | CO |
7264720 | AETNA PIN (01) | CO |
V06722 | (02) | CO |