Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 26939 | CA |
N | 111NR0400X | Rehabilitation Chiropractor | 5964 | CO |
NPI | 1255532719 |
---|---|
Provider Name | Dr. Theofiel Vanlondersele |
First Address | Grand Junction, CO 81501-7538 |
Second Address | Grand Junction, CO 81501-7538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 12/08/2010 |