Healthcare Provider Details

I. General information

NPI: 1992918395
Provider Name (Legal Business Name): RICHARD KEITH MOBUS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 S BROADWAY STE 150
DENVER CO
80210-1583
US

IV. Provider business mailing address

1970 S OGDEN ST
DENVER CO
80210-4133
US

V. Phone/Fax

Practice location:
  • Phone: 303-777-2777
  • Fax: 303-871-0218
Mailing address:
  • Phone: 720-570-8664
  • Fax: 303-871-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number3399
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: