Healthcare Provider Details

I. General information

NPI: 1497784649
Provider Name (Legal Business Name): MARCO VESPA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 HIGHWAY 6 AND 50 STE B
FRUITA CO
81521-2642
US

IV. Provider business mailing address

2501 15TH ST UNIT 1C
DENVER CO
80211-3986
US

V. Phone/Fax

Practice location:
  • Phone: 970-858-0544
  • Fax: 970-858-7749
Mailing address:
  • Phone: 303-433-0933
  • Fax: 303-433-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5928
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: