Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 6029 | CO |
N | 111NP0017X | Pediatric Chiropractor | 6029 | CO |
NPI | 1932247103 |
---|---|
Provider Name | Mary Katherine Ratz Mooberry |
First Address | Evergreen, CO 80439-2214 |
Second Address | Evergreen, CO 80439-2214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 24/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6029 | CO CHIROPRACTIC LICENSE # (01) | CO |