Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHR.0005699 | CO |
N | 111NR0400X | Rehabilitation Chiropractor | EL.2782841 | CO |
N | 111NS0005X | Chiropractic Sports Physician | CHR.0005699 | CO |
NPI | 1194741843 |
---|---|
Provider Name | Dr. Michael D Boerner |
First Address | Northglenn, CO 80234 |
Second Address | Northglenn, CO 80234-4125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 30/04/2021 |