Healthcare Provider Details

I. General information

NPI: 1942441217
Provider Name (Legal Business Name): RYAN C WEISGERBER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 W. DRAKE
FORT COLLINS CO
80526
US

IV. Provider business mailing address

1002 W DRAKE RD STE 102
FORT COLLINS CO
80526-5568
US

V. Phone/Fax

Practice location:
  • Phone: 925-595-0674
  • Fax:
Mailing address:
  • Phone: 970-484-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number6326
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: