Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 6202 | CO |
N | 111NP0017X | Pediatric Chiropractor | 6202 | CO |
NPI | 1720229941 |
---|---|
Provider Name | Dr. Jacob Randopf Sims |
First Address | Gunnison, CO 81230-2412 |
Second Address | Gunnison, CO 81230-2412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2009 |
Last Update Date | 06/08/2011 |