MEDICARE: LYDIA CHERIE ROSE RABORG DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHR.0009072	CO

General Provider Information

NPI Number	:	1306775168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA CHERIE ROSE RABORG DC

Provider Business Mailing Address
First Line	:	161 E 33RD ST APT 8
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-4213
Country	:	US
Telephone Number	:	505-250-4271
Fax Number	:

Provider Business Practice Location Address
First Line	:	561 25 RD UNIT 104
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1360
Country	:	US
Telephone Number	:	970-989-9219
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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