Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 6255 | CO |
N | 111NS0005X | Chiropractic Sports Physician | 6255 | CO |
NPI | 1386897908 |
---|---|
Provider Name | Dr. Justin Blake Dukes |
First Address | Denver, CO 80222-4011 |
Second Address | Denver, CO 80222-4011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 09/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1386897908 | NPI (01) | CO |