Healthcare Provider Details

I. General information

NPI: 1184738064
Provider Name (Legal Business Name): MICHAEL GUBNITSKY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 S FEDERAL BLVD STE B
DENVER CO
80219-3586
US

IV. Provider business mailing address

945 S FEDERAL BLVD STE B
DENVER CO
80219-3586
US

V. Phone/Fax

Practice location:
  • Phone: 303-922-8146
  • Fax: 303-922-0158
Mailing address:
  • Phone: 303-922-8146
  • Fax: 303-922-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4498
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9940
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: