Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1433 | CO |
NPI | 1548309305 |
---|---|
Provider Name | Richard K. Bauer |
First Address | Greeley, CO 80631-4611 |
Second Address | Greeley, CO 80631-4611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 16/05/2008 |