Healthcare Provider Details

I. General information

NPI: 1548595200
Provider Name (Legal Business Name): JOHN DOUILLARD D.C., PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6662 GUNPARK DR SUITE 102
BOULDER CO
80301-3386
US

IV. Provider business mailing address

6662 GUNPARK DR SUITE 102
BOULDER CO
80301-3386
US

V. Phone/Fax

Practice location:
  • Phone: 303-516-4848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2548
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: