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General NPI Number Information
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NPI Number | 1376746149
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Entity Type | Individual
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Provider Name | GREGORY W MORTIMER DC
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Gender | Male
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 3560 S BANNOCK ST
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City | ENGLEWOOD
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State | CO
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Zip | 80110-3626
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Country | US
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Telephone | 303-797-8850
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Fax | 303-957-2488
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Provider Business Mailing Address
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Address Line | 3560 S BANNOCK ST
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City | ENGLEWOOD
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State | CO
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Zip | 80110-3626
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Country | US
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Telephone | 303-797-8850
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Fax | 303-957-2488
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3478
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License Number State | CO
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