Healthcare Provider Details

I. General information

NPI: 1053418012
Provider Name (Legal Business Name): BOGDAN STAUCEANU D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/06/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 KELLY JOHNSON BLVD STE 111-4TH
COLORADO SPRINGS CO
80920-3932
US

IV. Provider business mailing address

1155 KELLY JOHNSON BLVD STE 111-4TH
COLORADO SPRINGS CO
80920-3932
US

V. Phone/Fax

Practice location:
  • Phone: 719-785-4840
  • Fax:
Mailing address:
  • Phone: 719-651-9617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHR.0007715
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: