MEDICARE: CHRISTOPHER MICHAEL GUBBELS 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 6256	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	COB4123	OTHER	CO	MEDICARE PTAN

General Provider Information

NPI Number	:	1437313509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER MICHAEL GUBBELS DC

Provider Business Mailing Address
First Line	:	257 E BOARDWALK DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5931
Country	:	US
Telephone Number	:	970-207-4046
Fax Number	:	970-207-4052

Provider Business Practice Location Address
First Line	:	257 E BOARDWALK DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5931
Country	:	US
Telephone Number	:	970-207-4046
Fax Number	:	970-207-4052

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

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	08/26/2016

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