Healthcare Provider Details

I. General information

NPI: 1679541338
Provider Name (Legal Business Name): DAVID L BICKNELL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 15TH STREET SUITE 310
GREELEY CO
80631-4563
US

IV. Provider business mailing address

1800 15TH STREET SUITE 310
GREELEY CO
80631-4563
US

V. Phone/Fax

Practice location:
  • Phone: 970-810-0900
  • Fax: 970-810-3795
Mailing address:
  • Phone: 970-810-0900
  • Fax: 970-810-3795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberDR.0065105
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberDR.0065105
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number16585A
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number16585A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: