Provider Demographics
NPI:1023178324
Name:LICHTENBERG, ALAN BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BRUCE
Last Name:LICHTENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 S CLARKSON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-1628
Mailing Address - Country:US
Mailing Address - Phone:303-698-2600
Mailing Address - Fax:
Practice Address - Street 1:1221 S CLARKSON ST STE 300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1628
Practice Address - Country:US
Practice Address - Phone:303-698-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19671204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM