Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 0007561 | CO |
NPI | 1164013751 |
---|---|
Provider Name | Ellen Kindelsperger |
First Address | Boulder, CO 80301-1105 |
Second Address | Boulder, CO 80301-1105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2021 |
Last Update Date | 27/01/2021 |