Healthcare Provider Details

I. General information

NPI: 1306775168
Provider Name (Legal Business Name): LYDIA CHERIE ROSE RABORG DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 25 RD UNIT 104
GRAND JUNCTION CO
81505-1360
US

IV. Provider business mailing address

161 E 33RD ST APT 8
DURANGO CO
81301-4213
US

V. Phone/Fax

Practice location:
  • Phone: 970-989-9219
  • Fax:
Mailing address:
  • Phone: 505-250-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.0009072
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: