Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 06918 | IA |
Y | 111NS0005X | Chiropractic Sports Physician | 0006936 | CO |
NPI | 1104914167 |
---|---|
Provider Name | Sergio A Rocafort |
First Address | Denver, CO 80219-3586 |
Second Address | Denver, CO 80219-3586 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 06/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0742619 | (05) | IA |
10025541100 | (05) | NE |
347932 | (02) | CO |
V11182 | (02) | IA |