Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 0007425 | CO |
Y | 111N00000X | Chiropractor | CHR.0007425 | CO |
N | 111NR0400X | Rehabilitation Chiropractor | CHR.0007425 | CO |
N | 111NS0005X | Chiropractic Sports Physician | CHR.0007425 | CO |
N | 225000000X | Orthotic Fitter | CHR.0007425 | CO |
N | 225100000X | Physical Therapist | CHR.0007425 | CO |
NPI | 1841652161 |
---|---|
Provider Name | Dr. Ryan Baack |
First Address | Aurora, CO 80012-4512 |
Second Address | Aurora, CO 80012-4512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2016 |
Last Update Date | 28/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CHR.0007425 | LICENSE (01) | CO |