Healthcare Provider Details

I. General information

NPI: 1356660955
Provider Name (Legal Business Name): GEBHARDT CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 S ALBION ST
DENVER CO
80222-4906
US

IV. Provider business mailing address

1309 S ELM ST
DENVER CO
80222-3521
US

V. Phone/Fax

Practice location:
  • Phone: 720-251-2201
  • Fax:
Mailing address:
  • Phone: 303-720-1487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR-6382
License Number StateCO

VIII. Authorized Official

Name: DR. RYAN DUKE GEBHARDT
Title or Position: PRESIDENT/SOLE OFFICER
Credential: D.C.
Phone: 303-720-1487